(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "The hospital as a social agent in the community"

WX 205 C365h 1918 



53620910R 



ISILM DSEfilfi7E b 

NATIONAL LIBRARY OF MEDICINE 



SURGEON GENERAL'S OFFICE 

^LIBRARY. 

Section 

W.D.S.G.O. 3-513 



/ 



The Hospital 
as a Social Agent in the 
Community 

Lucy Cornelia Catlin, R. N. 

Director of Social Service Work 
and Executive Director of the Out-Patient Department 
Youngstown Hospital, Ohio 



Illustrated 



Philadelphia and London 

W. B. Saunders Company 

1918 



geak^ 

LIBRARY 




W X 

Q,3(*5h 



r 



Copyright, 1918, by W. B. Saunders Company 



PRINTED IN AMERICA 



PRESS OF 
W. B. SAUNDERS COMPANY 
PHILADELPHIA 



To the Memory of my Aunt and Foster Mother, 

MARGARET ELIZA CATLIN 

This Book is Lovingly Dedicated, in Honor 
of Her Philanthropic Spirit and Unselfish 
Devotion to the Training and Care of 
Little Children, the Education of Young 
Women, the Uplift of the Fallen, the Aid 
of Families in Need, Besides the Countless 
Manifestations of Loving Thought for 
Neighbors and Friends, and the Living 
Inspiration of a Christ - like Life in 
Her Home 



PREFACE 



In offering this little book to the part of the world which is 
interested in social work, especially those engaged in hospital 
social service, the purpose of the author has been to present 
certain principles which she has found effective in establishing, 
developing, and maintaining the department in hospitals 
where she has been privileged to work. No special literary 
merit is claimed for it; no effort has been made in this direc- 
tion except to express the thoughts in a clear, concise, forceful 
way to prove the subject in hand. Case histories have been 
selected to illustrate different points in the text, and all of 
them are true records of actual cases handled. Even the mere 
reference to certain conditions and facts surrounding indi- 
viduals or pertaining to the point in question have their origin 
in the author's memory of a real case. She has thus endeav- 
ored to add weight to the statements and arguments through 
the avenue of true facts rather than theory. Probably any 
cases recited can be duplicated by social workers who read 
them; they have been chosen for illustration rather than for 
any especially remarkable features. 

The mission of the book is expressed in the following words 
by one who read the manuscript: "Your book will be a much 
needed, guide for social workers, especially in the new field of 
hospital work in smaller cities." Few hospitals in communities 
of any size exist in these days without a social service depart- 
ment, and as the years go by all hospitals will seek to broaden 
their usefulness by contributing in this way to public welfare 
work. Indeed, before many years pass the author hopes to 
see the hospital made the center for all the medico-social work 
in the community. 

7 



8 



PREFACE 



It is the author's hope that this volume may find its way 
into the hands of those who are estabUshing hospitals and 
dispensaries in new fields, and that it may be a help to them 
as well as to those who realize the* need of reorganizing and 
are at a loss to know just how to accomplish it. It was not 
expected to present suggestions adapted to the older, larger 
hospitals; their work differs in some measure. Social service 
originated there, and is now developing to meet the needs in 
smaller communities where co-ordination of all the forces in 
welfare work is both possible and desirable. 

The thought throughout the book has been to show how 
the hospital may be made an important social agent in the 
community, and to present a practical, working basis. For 
the benefit of workers in entirely new fields forms of blanks 
which have proved comprehensive and effective have been 
reproduced in the Appendix. Where it has been possible case 
histories have been written in regular record style, making 
notations under successive dates. Other cases are put in story 
form for the purpose of condensing, yet they illustrate how 
many of the histories may be written to good advantage, espe- 
cially those covering a long space of time with slowly develop- 
ing features. 

The author is indebted to Micheal M. Davis, Jr., Director 
of the Boston Dispensary, for his thoughtful review of the 
manuscript, and for valuable suggestions made by him. 
Many others also have lent kindly advice and encouragement 
which have helped to make the book what it is. 

May this small contribution to the cause of Hospital 
Social Service be a guide to workers, and through them a bless- 
ing to humanity which will redound to the glory of God. 

Lucy Cornelia Catlin, R. N. 

Youngstown, Ohio. 
May, igi8. 



CONTENTS 



CHAPTER I 

PAGE 



Reasons for the Existence of Social Service Departments in Hos- 
pitals 11 

1. Completion of Service to the Patient 11 

2. Help to Physicians and Surgeons in Diagnosis and Treatment 14 

CHAPTER II 

Out-patient Departments, and the Advantage of Establishing 

Them on a Social Service Basis -. . 17 

1. Organization of Early Dispensaries and the Development of the 

Need of Reorganization 17 

CHAPTER III 

Relation to and Correlation with Other Social Agencies. , 23 

CHAPTER IV 

Sickness or Injury — Dire Adversity and the Time When Social 

Service is Most Needed 32 

CHAPTER V 

Service to the Individual, to the Community, and to Society. . 40 

1. The Tuberculous Patient 41 

2. The Epileptic, Insane, and Feeble-minded Patient 45 

3. The Problem of the Unmarried Mother 47 

CHAPTER VI 

The Problem of the Hospital Child 58 

9 



IO CONTENTS 



CHAPTER VII 

PAGE 

Human Economy and Economy of Resources 67 

CHAPTER VIII 

The Place of the Hospital in Public Health Work 79 

Conclusion 86 

Appendix 88 

Facsimiles of Blanks Used in the Social Service and Out-patient 

Departments of the Youngstown Hospital 90-108 

Diagram Illustrating "Service and Co-operation" 109 



Index 



111 



" THE HOSPITAL AS A SOCIAL 
AGENT IN THE COMMUNITY" 



CHAPTER I 

REASONS FOR THE EXISTENCE OF SOCIAL SER- 
VICE DEPARTMENTS IN HOSPITALS 

1. Completion of Service to the Patient. 

2. Help to Physicians and Surgeons in Diagnosis and 

Treatment. 

The rapid development of social work in this country the 
past ten years is but an outcome of the growth in science and 
education, coupled with a broader philanthropic spirit which 
pervades the minds and hearts of our public-spirited citizens. 
Sociology and political economy are receiving an important 
place in the curriculi of universities and colleges; scientific 
research is enquiring into the causes of danger in the industrial 
and mining worlds; schools of philanthropy are training 
workers in the theory and practice of social work. These 
factors are educating the public to a realization of existing 
social conditions and setting the people to work to find the 
remedy for the unfavorable aspects of these conditions. 
Social work has become as scientific as medical work; the 
Russell Sage Foundation is the great social laboratory, as 
valuable to social workers as Rockefeller Institute or Phipps 
Laboratory is to medical science. 

ii 



12 "the hospital as a social agent" 

This is an age when philosophy and science are turning the 
microscope upon the causes of social sickness and maladjust- 
ment, as well as upon the microbes which are the cause of so 
many of the physical ills. The detection of the fundamental 
causes suggests the remedy, and treatment is much more 
effective than that which is directed to symptoms only. 

The analogy between social work and medical work is so 
close that we may find it profitable to call attention to it here. 
The social history of an applicant for aid includes personal and 
family history and present complaint; then symptoms are 
noted, including working ability of the wage earner, family 
harmony or discord, degree of industry, immorality or drunk- 
enness, poor management of money or family affairs, and many 
others. These symptoms are brought out by the social 
worker's investigation, just as the physical symptoms of a 
patient are shown in the doctor's examination by laboratory 
findings, :r-ray, etc. After examination follows diagnosis and 
treatment. Many times the social worker, like the physician, 
is able to diagnose as soon as the first history is taken, and there 
is no question what the general treatment should be. Idio- 
syncrasies must be taken into consideration as the treatment 
continues, and so each case becomes individual. Sometimes 
the nature of the disease is so obscure that it requires much 
study and time for development of symptoms before a true 
diagnosis can be made. Nomenclature and classification of 
social diseases may be as clearly defined as in medicine. 
There is an acute and a chronic state, climax and convales- 
cence, recovery or death; the social worker sees her people in 
all these stages, and her responsibility for the treatment is as 
great as that of the doctor. Malpractice on her part may be 
the cause of the social death of an individual, or of the infec- 
tion of a whole community, for sin and want and poverty and 
dependence are as contagious as smallpox. Prophylaxis is as 



COMPLETION OF SERVICE TO THE PATIENT 13 

much a part of the social worker's responsibility as that of the 
physician. 

This is the day of specialization in all lines of work; it is 
especially true in medicine, as we often find out, when it takes 
the combined efforts of the family physician, the surgeon, the 
eye specialist, the laboratory man, the radiographer, the 
neurologist, and perhaps a few others to determine the nature 
of our trouble and to treat it. In the field of social work there 
are just as many specialists, and they should be available for 
consultation and treatment along their special lines in solving 
the complex problems that arise. Relief agencies are best 
equipped to supply temporal needs and reconstruct the family; 
child placing associations, to deal with the homeless child; 
juvenile courts with the delinquent youth; and the hospital 
social service department with medical problems. There are 
accidents and emergencies where prompt action is necessary. 
The surgeon amputates a crushed limb to save a man's life; 
the social worker is called upon to act just as promptly if she 
finds a baby left at home with a drunken father when the 
mother has been rushed to the hospital in a serious condition. 
So the analogy might go on, and to the nurse who is doing 
hospital social service work it is very significant, for she learns 
to think and reason along these same lines, so that it becomes a 
part of her mental habit. 

That hospital social service should have developed along 
with other philanthropic organizations is only a most natural 
result of the advance in science and medicine; an outcome of 
the broader vision of thinking men and women. The work 
grew out of its own needs, and now is recognized as one of the 
special departments, as necessary in the successful treatment 
of patients as almost any of the others in the hospital. The 
hospital social worker is a "specialist" in the field of social 
work, and is consulted as such by outside agencies. Even in 



" THE HOSPITAL AS A SOCIAL AGENT " 



the hospital she is consultant, diagnostician, prescription 
writer in social problems, and her judgment is considered 
supreme in her sphere of activity. 

It is not necessary to review the history of hospital social 
service; it beginning in the mind and heart of a physician who 
came face to face with the needs of suffering humanity in his 
every-day hospital service. He recognized that these people 
were not getting all they needed, they were not receiving the 
benefit of the treatment that the doctors were trying to give 
them, yet what more could the physicians do? The gap was 
between the hospital, dispensary, doctor, and the home. 
The home, that integral part of society and of a nation upon 
which depends health, wealth, and happiness. The social 
service nurse has become the bridge over this gap, and she it is 
who co-ordinates the forces to bring about the completion of 
service to the patient. 

The case of Mrs. J. well illustrates this. Mrs. J. was a 
hard-working, respectable colored woman who was referred 
to the dispensary by a lady for whom she worked as laundress. 
The doctor's examination showed a pelvic condition which 
needed surgical treatment, and also cardiac symptoms re- 
quiring rest in bed. She was advised to enter the hospital for 
medical treatment. This seemed to her an impossibility, and 
the social worker, already familiar with the family history, 
came forward to help her to plan to carry out the doctor's 
order. The social history was as follows: Mr. J. was in the 
penitentiary for the murder of their oldest daughter. The 
support of the family, which consisted of two boys and one 
girl, devolved upon the mother, and she had worked very hard 
to have the children cared for and kept in school. The probate 
court had granted her a window's pension of $15.00 a month, 
but she did laundry work beyond her strength, which had been 
the cause of her heart's overstrain. Even before her husband's 
murderous deed she had been obliged to help in the family 
support, as he was too shiftless to hold steadily to work. How 



HELP TO PHYSICIANS AND SURGEONS 



15 



was she to leave her children and come to the hospital? That 
was her problem. Following a visit to the home by the social 
worker, Mrs. J. was able to arrange with two of her friends to 
take the two younger children, and the oldest, a boy of fifteen, 
could be left at home with the minister to keep a watchful eye 
over him. She then entered the hospital as a city-paid case 
for the rest and medical treatment she was so much in need of. 
Three weeks showed a marked improvement, the medical 
doctor called the surgeon in consultation, and the decision was 
that an operation was necessary to put her in shape to take 
care of her family as she should, and the doctors advised her 
to remain for it, as she was in better condition than she would 
be if she went home to her work again. But she said, 
"Doctors, I cannot stay, for I cannot leave my family so long. " 
The facts were reported to the social worker, who talked over 
the matter with her, and set to work to arrange the home affairs 
so that it would be possible for her to remain in the hospital 
for the operation at this time. The pastor was called upon to 
look after the oldest boy and get him employment if possible, 
a friend to keep the girl, and the Fresh Air Camp to take the 
youngest boy. The minister advanced the money for the pay- 
ment of insurance dues, which she was anxious to keep up, as 
this provided in part for her children should she be taken. 
Her mind was then at rest, and she went through the operation 
well, made a good recovery, and returned to her family in 
condition to be of service to them. A year and a half has 
passed since then, and she has gone back to her former work, 
her son has secured a good position, and the family is not only 
self-sustaining, but they have saved enough to pay off some 
old debts which Mr. J. incurred before he went to the peniten- 
tiary. How incomplete would have been the doctor's and the 
hospital's service to this woman if the work had stopped at the 
dispensary after the examination had been made and advice 
given. 

This example illustrates the advantage of the social history 
in the physician's diagnosis and of the social service in his 
treatment. It also shows the importance of team work be- 



1 6 " THE HOSPITAL AS A SOCIAL AGENT " 

tween social worker and doctor in order to secure the best 
social and economic results. The dispensary patient or the 
free hospital patient is entitled to the best medical treatment 
which can be offered. The staff doctor who is giving his time 
to them is entitled to every aid from the social worker to carry 
out adequate treatment. Without it his efforts may be futile, 
and his discouragement will lead to indifference or a desire to 
make the patient the victim of experimentation. If this re- 
sults, medical and hospital standards are lowered, public con- 
fidence is lost, and best service to the individual, to the com- 
munity, and to society is withheld. 

The time is coming, and may not be far distant, when hos- 
pital staff physicians will receive compensation for their pro- 
fessional services to so-called free patients, not because they 
have not given their best service in the past, but because the 
public demands a greater service than doctors are able to give 
freely and at the same time earn their livelihood. The patient 
who, by reason of circumstances, is obliged to seek free medical 
advice is entitled to the best treatment that can be provided, 
not alone for his own sake, but for the sake of the community, 
which is thus spared the danger from spread of disease, and 
from the necessity of caring for dependent individuals. 

By maintaining a high standard of medical efficiency hos- 
pitals are in a position to render the highest service to the com- 
munity in public health work, and such an equipment will com- 
mand the respect and confidence of the public, especially if 
it is coupled with an efficient social service department. 



CHAPTER II 



OUT-PATIENT DEPARTMENTS AND THE ADVAN- 
TAGE OF ESTABLISHING THEM ON A SOCIAL 
SERVICE BASIS 

Organization of Early Dispensaries and the Develop- 
ment of the Need of Reorganization 

The need of the unification of social service work in hospital 
wards and in the out-patient department cannot be too strongly 
emphasized. The social service department of a hospital 
should embrace all departments of the organization where 
social work is needed, the worker being at least consultant if 
she is not the logical person to follow out details. Between 
the dispensary and the hospital there should be the closest 
relation both as regards medical and social work. Whether 
or not the same medical staff serves in both places at the same 
time, there should be co-operation and co-ordination for the 
best interests of all, and the social service department links 
these forces and interests. The hospital organization today 
stands as one of the chief agents of public health, it cares for 
the injured and acutely ill in its surgical and medical wards, 
for those suffering from contagious diseases in its isolation 
ward, and for ambulatory patients in its out-patient depart- 
ment. Its medical, nursing, and social service equipment must 
be adequate to meet this responsibility. 

Social service needs were first recognized in the dispensary, 
and the department developed from this point to include 



2 



17 



18 "the hospital as a social agent" 

hospital ward patients. Let us, therefore, look back into the 
history of dispensaries that we may better account for the 
development of the need for reorganization. 

As the root of the word implies, a dispensary is a place 
where certain things are dispensed to those who ask, and the 
term came to be applied more exclusively to the place where 
drugs or medicines were given out free of charge to needy 
patients. Probably there have been dispensaries in some form 
ever since there have been doctors, for sickness comes to rich 
and poor alike and seeks relief, but the wide-spread establish- 
ment of dispensaries came with the development of medical 
education. It was a demand of medical schools in search of 
clinical material, and the demand is justified now as well as it 
was then. The physician with the large experience in free 
hospital service is the one who gains and holds the greatest 
public confidence. It is an old saying that "physicians ride to 
eminence on the backs of the poor." Many of us owe our 
lives to physicians whose skill has been acquired and ex- 
perience gained in the free treatment of patients. 

Dispensaries have an important field in medical education 
not only for the student of medicine, but for the postgraduate, 
and recognition must be given to this phase of the work. But 
there is another side which now demands attention and which 
has led to the reorganization of dispensary work. Individual, 
community, and society interests occupy the part of the field 
now being cultivated, and which calls for the united efforts of 
physicians and social workers, the "team work," as Dr. Cabot 
calls it, which is so essential to success. This large part of the 
great field of human life and economy is now being occupied 
by experts who have driven their stakes, laid their claims, and 
proved their rights. It now remains for these experts to show 
what the field will yield for the betterment of the human race 
under their scientific cultivation. 



ORGANIZATION OF EARLY DISPENSARIES 1 9 



It is only within the last decade that newly organized dis- 
pensaries have been placed upon a social service basis. Here- 
tofore they were established on a medical basis because the 
medical side of the work was naturally the first thought, and 
dispensaries connected with old hospitals or with teaching 
hospitals will no doubt remain for some time to come under 
medical supervision. In these dispensaries there has been 
introduced the Social Service Department to which the doctors 
refer cases in need of any kind of social service. Many of these 
departments are covering all cases in certain clinics where 
there is always need for service. Few surgical clinics require 
general follow-up work, and those patients who do may be 
easily referred to a social worker. With medical cases the 
need is greater. All tuberculous patients, all orthopedic cases, 
practically all children, all mothers with babies, all gonorrheal 
and syphilitic patients should be social service cases for more 
or less intensive work. This plan is generally followed now in 
the larger, older dispensaries where the daily attendance is too 
large to make any other procedure possible. 

Whatever the organization, or whatever the plan of work, 
the department no longer needs an excuse for its existence. The 
importance of social work in connection with hospitals and dis- 
pensaries has been established, and is now recognized as a 
necessary factor in completing the hospital's service as a social 
agent in the community. 

The superintendent of one of our large city hospitals bit- 
terly opposed the introduction of social service into his institu- 
tion, and allowed it only under protest. A few years after, 
when the department was well established and demonstrated 
every day its value, this same superintendent was asked how 
he regarded it then. His prompt reply was, "I consider it of 
inestimable value; I would rather give up almost any depart- 
ment in the hospital than social service." 



20 



" THE HOSPITAL AS A SOCIAL AGENT " 



In the general public health program it is indispensable, 
and herein its latent possibilities lie. What social worker is 
better able to know the menace of physical defects and disease 
to the individual and society than the nurse doing social work 
in the hospital? And who is in a better position to remedy 
these defects, and to bring about the cure or isolation of these 
diseases than this nurse? 

The hospital has always been an important agent in the 
community for the benefit of society in caring for the sick and 
injured, and as medical science and surgical skill have devel- 
oped, the hospital has grown wonderfully in its usefulness. But 
with the introduction of the social worker the hospital has 
been placed in the forefront as a medicosocial agent, and its 
service as such depends upon the scientific, practical, sensible 
development of the social service department. Hospitals must 
realize their responsibility in this direction and turn their 
attention to the working out of the underlying principles. 

As new lines of work spring up which especially appeal to 
the public mind, they are bound to pass through a period of 
excrescent growth, they are like wounds which throw out 
excessive granular tissue in their overabundant effort to heal. 
Generally speaking, hospital social service has suffered as little 
in this direction as any of the lines of benevolent work of recent 
development. Fortunately for the work its pioneers have 
been men and women of conservative thought, broad vision, 
and practical experience, and they have laid foundations upon 
which a superstructure is being built that will stand. 

Let us urge, therefore, that hospitals in the smaller com- 
munities who are planning to establish social service work keep 
in mind their responsibility as a social agent in the com- 
munity; then, when the dispensary is opened, it should be es- 
tablished on a social service basis and come under the direction 
of the social service department. This will bring about the 



NEED OF REORGANIZATION 



21 



unification spoken of in the first part of this chapter, the ad- 
vantages of which will be shown later. 

May we describe a model organization along the lines of the 
theories set forth, that we may best illustrate the reasons for 
such a plan. 

One of the first requisites is the selection of a well-qualified 
woman, preferably a graduate nurse, but one who has a broad 
conception of the hospital's opportunity and obligation, the 
patient's needs, the doctor's service, and the community's 
problems. She should be the admitting officer in the dis- 
pensary, taking the social history of all applicants, basing her 
judgment of the eligibility of the patient for free treatment 
upon this history, and upon the liability of his becoming a 
menace or a burden to the public if treatment is denied. 
With this initial touch the social worker is prepared to be of 
special service to the patient and to the doctor whenever there 
is need, and, by further investigation, to take up any deeper 
problems that are indicated. 

The head worker should be the executive director of the 
dispensary, responsible for the proper conduct of the operation 
•of its service, and helping to lay out its policies and plans for 
development. She should see that every possible aid is given 
the doctors in the examination and treatment of patients, to 
conserve their time, and to complete their service. Through 
her assistants, follow-up work should be done wherever it is 
necessary to carry the doctor's directions to the home, to secure 
the patient's return to the dispensary, or to arrange for relief 
or transfer to other agencies or institutions. 

If, after examination, a patient is referred to the hospital 
wards for treatment or operation, arrangements may be made 
through the social service department for his admission either 
as a free or part-pay patient, suiting the time for his admission 
to the needs of the case, to the family convenience, or to the 



22 



"the hospital as a social agent " 



number of available beds on the ward. Often the social worker 
may help to persuade or assist in overcoming prejudices or dif- 
ficulties, through her friendly interest and advice. This case 
may be followed into the hospital with any social service that 
is needed, and if necessary returned to the dispensary for treat- 
ment or observation. Thus the completion of service to the 
patient is accomplished, and the doctor is able to see the results 
of his work in diagnosis in the treatment which it is possible 
to have carried out. Team-work like this, bringing such satis- 
factory results which spread out into the community, effecting 
the home-life of its members, and proving to the medical 
profession the possibilities of scientific treatment, furnishes 
just encouragement to both social workers and doctors. Both 
are inspired to put forth best efforts for the amelioration of 
physical suffering and social distress, and with such co-opera- 
tion the success of the dispensary is assured. 

It must be the definite purpose of the social worker either 
in the hospital or dispensary, first, to procure adequate treat- 
ment for the alleviation of suffering, or for the removal of a 
handicap in the individual; second, to assist in combating 
disease in the community; and third, to take up the more dis- 
tinct social problems which effect the life and health of the 
community and the state of society. 

The province of the dispensary is extending far beyond the 
clinic walls, until it now reaches out into the community as a 
public agent. This is the need which has brought about a 
readjustment by the injection into the operation of dispen- 
saries social service principles and public welfare interests. 



CHAPTER III 



RELATION TO AND CORRELATION WITH OTHER 
SOCIAL AGENCIES 

The social worker in her travels about the city for the pur- 
pose of investigation and service makes many trips on the 
street car, and has many waits which are unavoidable, but 
she learns to use these hours of apparent waste in the study of 
human nature with which she comes in contact, or in thinking 
out some of the life problems that are puzzling her. She 
comes in touch with many factors which constitute and influ- 
ence the life of individuals, and observes their setting in society 
and in the community. Indeed, the many hours of travel or 
waiting are precious ones if they are used for observation and 
thought. 

On the car this morning is a working man with his dinner- 
pail going to work to provide food, shelter, and clothing for the 
family at home. The mind at once pictures the home, with 
the influences there which make or break society, and we real- 
ize our responsibility in helping to maintain and upbuild that 
home. 

In the corner, sitting all in a heap, is a poor specimen of 
drunken humanity, sleeping his way along, scarcely aware of 
any desired destination, empty handed and empty headed, an 
undesirable individual, and seemingly hopeless. It is not hard 
to trace the train of influences which are responsible for this 
downfall, and as our eyes glance out of the car window while 
we pass through the main street, the saloon, which is much 

23 



24 "the hospital as a social agent" 



in evidence, points out the cause of this effect with which we 
are riding. 

At Griffith Street, a man well along in years and rather 
under par physically, boards the car, carrying a few pieces of 
aluminum ware. We recognize him as a patient who has 
visited the dispensary, and we recall the history he gave. He 
is a widower, without children who are willing to make a home 
for him, past the age to be employed for heavy, responsible 
work, yet he maintains a worthy spirit of independence by 
endeavoring to earn a respectable living for himself. We 
know from the doctor's diagnosis that his earning capacity will 
not long be sufficient to meet even the bare cost of his living, 
and a feeling of pity passes over us as we contemplate what his 
future may be. 

Next, the visiting nurse on her rounds of ministration joins 
us, and she tells of a family which she has just left, where three 
of the children are fighting the battle with pneumonia. The 
father must keep at his work to meet the extra expense brought 
by this sickness, for the children must be spared if it takes his 
last penny to pay the doctor. The mother is left at home to 
watch and wait for the crisis which will decide the battle. We 
are reminded of the old song with its chorus, 

"For men must work and women must weep, 
For there's little to earn and many to keep." 

But we cannot muse longer, for the car has reached the 
street where we must get off. Up the hill we go, turn to the 
right and enter a house, following the lead of a lad of ten years 
to the room where his mother lies in bed. She is about to be 
confined and is already in labor, yet has no doctor to attend her, 
no one to take care of her and the baby, no fire in the house, 
very little food for the other four children, no money, and last, 
but by no means least, her husband has left her in such a plight. 



CORRELATION WITH OTHER SOCIAL AGENCIES 25 

What can be done? It is no place for a baby to come, even if 
a doctor can be secured, and there is no time to be lost. She 
must go to the hospital, and a neighbor sought to care for the 
children until the next day, when some arrangement can be 
made for them until the mother can return. The bed upon 
which the woman lay was the only one they had, the children's 
mattresses lay on the floor, and the rooms were almost divested 
of furniture. They had bought on the instalment plan, and 
most of the furniture had been confiscated because of failure 
to make payments. The little woman, a Hungarian, was 
earnest and courageous, she had trained her children as best 
she could, her house was neat and clean, but her Jewish hus- 
band had a habit of disappearing at this critical hour and 
leaving her to the mercy of passersby, she being fortunate if 
the "Good Samaritan" chanced that way. 

As we go on our way to work out this problem we find our- 
selves wondering why this maladjustment exists, what it is in 
man that freezes his heart against his duty at such a moment 
when woman faces the anguish and suffering for him and his 
child? 

Our next visit is to the basement of a dirty, dingy building, 
where we find a drunken man, a blind woman, a feeble- 
minded boy of fifteen, and a six-year-old girl who has no cloth- 
ing on but a dress, and her hair is one mass of filth and vermin 
and scales. The tin cans from which the family ate their last 
meal are on the dirty table, the corners of the room are filled 
with refuse, dirt and tin cans, where it has been swept to make 
room in the middle of the floor to get about. The feeling of 
revolt which we have and the creeping, crawling sensations 
may easily be imagined. We retrace our steps to the car, 
realizing that there is little more than the animal nature in 
such human beings. 

On the return trip to the hospital the car is delayed some 



26 " THE HOSPITAL AS A SOCIAL AGENT " 

time by a large traction engine belonging to a construction 
company which is relaying and reconstructing the street car 
track. The powerful engine is driving its shovel under the 
track, tearing it up and lifting ties, brick, dirt, and everything 
into the air. Then slowly the great arm swings about, the 
engineer manipulates the levers, and the shovel lets go of its 
load, dumps it into carts to be hauled away where materials 
are sorted, some thrown away, and others set aside for the work 
of reconstruction. A short distance up the track the other 
machinery is at work laying the rails and filling in with gravel 
and cement and we see the completed work. 

Efficient social work in the community is just as construc- 
tive as this material work, differing only in completeness of 
finish because of the human material with which we have to 
deal. It is like a great chain in the hands of the Almighty to 
lift people from the bed of want, degradation, poverty, sick- 
ness, dependence, and unwholesome surroundings, to swing 
them about and drop them on new ground where there are 
new opportunities for readjustment. Each social agent in the 
community is a link in this chain, and effective work depends 
upon the efficiency of each agent and the working together of 
all. The day of miracles is past. The Almighty chooses to work 
through human agents, but how can He lift the load if even one 
of the links of His chain is weak, or if all do not pull together? 
Efficiency and co-operation must be welded together to make 
each link, if the work of social readjustment and reconstruc- 
tion is to be accomplished. 

This crude figure illustrates what is meant by the relation 
of hospital social service to, and its correlation with, other 
social agencies in the community. The social service depart- 
ment of the hospital should be equipped to take care of the 
medicosocial problems which come to the hospital or dispen- 
sary, and its work should be so efficient that public confidence 



CORRELATION WITH OTHER SOCIAL AGENCIES 27 

is assured. On the other hand, it cannot be adequate to 
proper child placing, or family reconstruction, or relief work, 
and therefore it is dependent upon other organizations. 

Let us recall the cases cited in the first part of this chapter, 
and point out the correlation and interdependence that is abso- 
lutely necessary for the most successful accomplishments in 
social welfare. First, here is the man with the dinner-pail, all 
honor to him and his insignia, the pail. He represents an 
honest struggle for independence, the man with the steady job, 
equal to the support of himself and his family when work is 
plenty, and all goes well with the wife and children. But there 
is no surplus, and when sickness or adversity comes, his re- 
sources are soon exhausted and he must have help. His own 
injury or the illness of one of the family may be the means of 
their introduction to the hospital social worker, and her first 
duty is to help bring about adequate medical treatment by co- 
operating with the doctor in every possible way, acquainting 
him with the social history if it will aid in his decision. It is 
the responsibility of social workers to preserve the home unless 
the good of the individuals or of the community demands that 
it be broken up. All the forces that are necessary to be called 
into play, therefore, should be directed to the preservation of 
this home where sickness or injury has made its inroad. The 
agencies giving hospital care, relief, temporary loans, or tem- 
porary care for the children should work shoulder to shoulder 
to this end. 

This poor fellow in the corner of the car is most likely to 
fall a victim of accident and be sent to the hospital for repairs. 
Possibly a limb must be amputated, then as the days go by the 
social worker asks what of the future for this man, crippled, 
penniless, homeless, morally broken. The day is coming when 
the doctors will discharge him "cured," but where is he going? 
What is he going to do? He is a more useless member of society 



28 



" THE HOSPITAL AS A SOCIAL AGENT " 



than he was before. Disregarding for the time being the man 
himself, with whom it is hard to sympathize, what is best to do 
with him for the community's sake to relieve its burden? 
The treatment is evident— reform the man, secure for him an 
artificial limb, then find proper surroundings and get him work. 
This is more easily said than done, but work must be directed 
toward this end, and it will take the combined efforts of a 
number of individuals and agencies to even make a beginning 
toward success. Incidentally, the social worker should use 
all the influence which she can bring to bear upon the abolish- 
ment of the source of evil which has been the means of bring- 
ing about this combination of disasters. 

The man with the aluminum ware, whom we are treating 
in the dispensary, calls forth our interest because the time is 
coming when he will be obliged to give up his independent life, 
as he will no longer be able to be self-supporting. We may 
prepare for this time by a personal, friendly interest shown in 
his welfare as we see him from time to time, or possibly by 
putting him in touch with some church or some organization 
which may be able to find a better home and other occupation 
with less risks and surer pay. It is not enough for that man 
to merely eke out an existence as he is doing, he needs the friend 
who will help him with the burden which is too heavy as he is 
trying to carry it. With his physical strength conserved, he 
may be able for a longer time to maintain his independence. 
So, if the social worker cannot enter into this problem to carry 
it out successfully, she should call upon the agent which is the 
best in this individual case to give the most adequate service. 

The district nurse reminds us of one of the most important 
co-operating organizations. It is she who will go to the home 
and treat the baby's discharging ear after the dispensary doctor 
has prescribed for it; she will watch for unfavorable symptoms, 
and send the mother back with the child for further examination 



CORRELATION WITH OTHER SOCIAL AGENCIES 29 

and treatment. The district nurse is one of the first aids to the 
social service department in the hospital. 

The woman deserted by her husband, and left so desolate 
when in the throes of childbirth, asks nothing, but her need 
calls for prompt, concerted action. The agencies co-operating 
are the hospital, the neighbor who takes the four children in her 
home for temporary care, the ambulance service, the Jewish 
Charities, the husband's mother and sister, the juvenile court, 
and the Children's Home. Her baby 'was born soon after she 
reached the hospital, the boys were committed temporarily to 
the Home, the little girls went to the grandparents' to stay, 
and the Jewish Charities took up the family problem when 
the mother returned from the hospital and the family was re- 
united except for the return of the father. 

The next home, where drunkenness, blindness, feeblemind- 
edness, and filth are combined, we see no way except to break 
it up, for the sake of the children, the mother, and the com- 
munity. The first touch with this family was when the woman 
came to the dispensary with her eyes in very bad condition 
and her sight much impaired. With treatment prescribed, 
the case was referred to the visiting nurses for supervisory 
care in the home. She did not improve, and the nurse tried 
for four weeks to get her to return to the dispensary, but in- 
stead she found her way to a general practitioner, who pre- 
scribed certain drops for her eyes. After a few applications of 
this drug her eyes were so much worse that she returned to the 
dispensary, and it was then discovered by the oculist that a 
drug had been used which was contraindicated in the disease 
from which she was suffering and her sight was almost gone. 
Although by this time her eyes were past repair she was ad- 
mitted to the hospital wards, that everything possible might 
be done in the effort to save her vision. It was unavailing, for 
the harm had been done, she was hopelessly blind. Followed 



30 " THE HOSPITAL AS A SOCIAL AGENT " 

back to the home when she left the hospital, accompanied by 
the blind teacher, we found the hopeless condition described 
above, the filth being the most desperate factor. The little 
girl was sadly in need of attention, as the condition of her head 
.was due to filth and neglect, the boy of fifteen had a mind of a 
four-year-old child, and he had been excluded from school be- 
cause he was a moral pervert and a menace to other pupils. 
The man, a drunken, shiftless being, was abusive and did not 
provide for his family; they could not buy from neighboring 
stores without money, as their credit was gone, and the woman 
and children often went hungry. 

Here we have a most desperate situation that can only be re- 
lieved by disintegrating the home. This is accomplished by the 
Charity Organization Society's investigation, and the prosecu- 
tion of the parents for neglect of the children by the Humane 
Society in the juvenile court. Hospital social workers, visit- 
ing nurses, school teacher, resident of a neighborhood settle- 
ment house, and the truant officer are called as witnesses, and 
the judge sends the little girl to the Children's Home, the boy 
to the State Bureau of Juvenile Research, and the mother to a 
blind industrial home. There being no adequate means in the 
city to forcibly put the man to work as an act of punishment or 
for the purpose of keeping him out of trouble, he was left to his 
own destruction through the sure channel of the police court. 

The hospital social service department is not fitted to meet 
all these situations, neither should it expect to be; others are 
better fitted by position, equipment or authority to work 
out the more intensive, complex social problems, or, in other 
words, they are specialists along their different lines, and should 
be consulted as such. 

Duplication of work is avoided by such co-operative plans. 
A program well thought out to meet the requirements of a cer- 
tain family problem may be entirely upset by independent, in- 



CORRELATION WITH OTHER SOCIAL AGENCIES 3 1 

dividual work, and the good that might be accomplished is com- 
pletely overthrown. Hospital social workers have no more 
right to interfere in general family reconstruction that is being 
handled by associated charities than the latter have to dictate 
the kind of treatment a patient should receive whom they are 
sending to the hospital. This sort of interference indicates 
low standards of social work, a narrow conception of the indi- 
vidual and community needs, and should not be tolerated. 
The interests at stake are too vital to be dealt with in any spirit 
of self-interest or dominance of opinion. Social work in the 
community should be as complete a unit in operation as the 
medical and social work in a hospital, which functionates as an 
individual, each department being available for consultation 
in any case where it is indicated. 

It is most gratifying to note the splendid organization that 
has been effected in some of our cities, and we believe it ap- 
proaches the ideal, at least it gives us a basis upon which to 
work out the best plan for co-ordination and correlation of 
forces for community welfare work. It is not a part of the 
subject of this book to go into the details of such an organiza- 
tion, but we hail the day when there shall be a unified central 
plan for the management of all welfare agencies in communities 
large enough to contain the complex social problems. 



CHAPTER IV 



SICKNESS OR INJURY— DIRE ADVERSITY AND THE 
TIME WHEN SOCIAL SERVICE IS MOST NEEDED 

It is often true that sickness or injury to one member of 
the family becomes the first occasion for any necessity for 
outside help, and, as the hospital social worker is dealing with 
the sick and injured, naturally her introduction to the patient 
may mean the beginning of some more or less intensive social 
work in that home. Surely sickness or injury may prove to be 
dire adversity in many cases, and affords the opportunity for 
"the study of character under adversity" which Dr. Cabot 
says is "the essence and center of social work." We have 
often seen strong men melt under the ravages of disease, and 
express a desire to see mother or wife or sister to whom they 
owe much, yet have become estranged through a wandering, 
dissolute life. This is the psychologic moment to do all that 
is possible to bring about a reconciliation and send the man 
away from the hospital with a new determination. Often 
it takes a severe shock to bring a man to his senses, and even 
if he does seem hardened to all good influences, or we feel is 
apt to retrace his steps afterward, we must make the most 
of our opportunity, realizing that our work at this time is like 
bread cast upon the water, and we may find it after many days. 
It is not sufficient to concentrate our efforts while he is in the 
hospital; our work is almost sure to be a failure unless we follow 
it by putting him in touch with an outside agency that will 
continue the good influences. 

We recall one man in whom we felt interested, and put in 
touch with the Y. M. C. A., a settlement house, and a minister, 
32 



SICKNESS OR INJURY 



33 



after he left the hospital, in our effort to bring about his 
reformation, obtain work, and secure some further education 
for him. He tried, and stumbled along, and fell and rose, 
passing through the jail several times, having delirium tremens, 
went to the county house, returned to town, and got into jail 
again for drunkenness. Finally, by the tactful handling and 
good influence of the minister who kept in touch with him 
through all these vicissitudes he straightened up, returned to 
his wife, and obtained work. 

In this case the hospital touch was the social worker's 
opportunity to inaugurate some work which proved effective. 
Often patients need a friend, only a friend, to take an interest 
at this moment in their lives and give them courage to go on 
after they get well, to show them that there is some good in 
this world which has seemed to use them so roughly. 

There is another class of cases, however, where sickness is 
a dire calamity, and which calls for the truest kind of service, 
when the breadwinner of the family or the mother is stricken 
and adversity first enters the home. They may struggle along 
by themselves in their endeavor to maintain their independ- 
ence, but when resources are exhausted they are obliged to 
seek advice and help. The social worker in the hospital, be- 
cause of her acquaintance with the medical side, foresees this 
result, and starts her work in time so that the extremity may 
not be reached. Or she is in a position to advise an outside 
agency, already handling the family problem, what the result 
of the illness or injury may be or the length of time the patient 
may be incapacitated. 

In case of tuberculosis or insanity or chronic disease co- 
operative action may be taken for the patient's transfer to an 
institution, and the care of the family arranged for. In the 
dispensary, disease is often discovered in its incipient stage, and 
with prompt, adequate treatment, medical and social, the 

3 



34 



"the hospital as a social agent" 



patient may be saved much time and suffering and the com- 
munity a danger and burden. 

Some people are utterly unable to meet adversity, especially 
that of sickness, and they need the most careful, tactful help 
to brace them up or to press home to them their part of the 
responsibility. Sometimes their helplessness is pitiful; this is 
especially so with a husband who is left with the baby at home 
when his wife must come to the hospital ; he has no idea what 
to do. Also an aged person, separated from the companion 
of many years, often seems as helpless as a child. 

So a most valuable opportunity comes to the worker in the 
hospital to accomplish most effective social work as well as to 
assist in bringing about most urgent medical or surgical care. 
A mother who fears to leave her child in the hospital to have 
an abscess opened may have those fears overcome by the 
friendly visitation and urgent entreaties of the social worker, 
and once the mother's confidence in the hospital is gained by 
successful results, it remains steadfast. Here once more is 
demonstrated the doctor's aid in treatment through the co- 
operation of the social service department. 

Hospital social workers have opportunities for service that 
are not accorded to others: first, because sickness or injury in- 
capacitates the individual, rendering him helpless and de- 
pendent; second, because his helplessness makes him more sus- 
ceptible to good influences; third, because his stay in the 
hospital brings him under direct observation and care; fourth, 
because most complex social problems may develop from the 
patient's illness, calling for intensive work. 

Jake, John, and the Mission Man 

In Fig. 1 are seen three patients snapped while taking their 
outing on the hospital lawn, and they represent three different 




Fig. 1. — Jake, John, and the Mission man. 



JAKE, JOHN, AND THE MISSION MAN 



35 



types of cases to which principles set forth in the foregoing 
chapter may be applied. 

Jake, a Russian Jew, had been in the hospital a long time, 
suffering from a diseased ankle, which had not yielded to treat- 
ment, and the doctor finally told him his foot would have to be 
amputated. He had a wife and several small children at home, 
and he could see nothing but dependence for all of them if he 
were deprived of his foot. He brooded over this until he be- 
came desperate, and one day secured a razor from another 
patient in the ward, went into the toilet, and cut his throat. 
Fortunately he was found almost immediately, and hurried 
to the operating room, where doctors were sewing the wounds 
and inserting a tracheotomy tube within twenty minutes. 
Jake recovered, and soon realized what a foolish trick he had 
done. He was most grateful to all who had worked so hard 
to save his life that he might have it for his family. A spirit 
of encouragement and cheer was thrown about Jake during his 
convalescence, and he viewed life in a different light. The 
Jewish Charities were called upon to take up the family 
problem, and, through their interpreter, they were able to 
assure him that his wife and children should not want while 
he was in the hospital. One of the most remarkable parts of 
this story is that while Jake's neck was healing his ankle got 
entirely well, and the doctor was deprived of his amputation 
job. While Jake's own operation at the other end of the line 
brought such favorable results, we would not advise other 
patients to try it. Jake looks quite content sitting on the 
bench with his wife and child, and he was indeed happy then. 

John, the boy standing on crutches, had a tuberculous knee. 
When he came to the hospital he was rescued from among the 
little "wharf rats" that hung around the boat landings, so he 
needed much taming down in conversation and in actions. 
The effect of hospital discipline and kind treatment of hospital 
attaches was soon manifest, and John became quite a respect- 
able and respectful boy. One time, after weeks of confine- 
ment, John borrowed without leave a pair of crutches from one 
of the other children and disappeared from the ward. He was 



36 



"the hospital as a social agent" 



discovered at home and brought back by his mother. For 
a year he was in and out of the hospital, attended the dispen- 
sary, and was visited by the social worker to keep him in line, 
all for the purpose of saving a boy from being a lifelong 
cripple and making something better than a vagabond when 
he grew up; indeed, something approaching a worthy citizen. 
Both of these were saved for the home. 

The Mission Man was one of those single, unattached men, 
who had been rescued by a city mission, and who was trying to 
make amends for his past useless life. But health was gone, 
he was suffering from a kidney trouble which incapacitated him 
for work which would keep him independent, and was destined 
to become a burden to someone somewhere. This is a type of 
case representing very little service that can be rendered by 
the hospital social worker, yet needing the friend who will see 
that a clean, comfortable place is found for him when the hos- 
pital can do no more in the way of treatment. It is only a 
question of a permanent home, but that must be managed in a 
kind, friendly way, that the man may not feel his desperately 
dependent situation. So the Mission Man stands in the back- 
ground of our picture, alone in the world and dependent upon 
it; apart from the other two, whom we are endeavoring to put 
into their places in the world for service to themselves and to 
others. 

The "A" Family 

Italians; children — boy, age eight; twins, age four; baby, 
age four months. 

This case illustrates the complex problem which may de- 
velop when sickness brings dire adversity. 

A young Italian woman was referred to the out-patient 
department by the visiting nurses because she was in an ex- 
tremely nervous state, and unfit to care for her children and 
her home. Her husband had died in the hospital the previous 
week, entering as a private patient, yet she was so destitute 
that she did not have shoes to put on to come to the hospital 
when summoned at the time of his death. After the doctor 
examined her in the dispensary he thought it would be best 
to place her on the ward for observation and treatment. It 




Fig. 3. 

Figs. 2 and 3.— The "A" children in the "Home." 



THE a A" FAMILY 



37 



was hoped that rest, good food, and a change of surroundings 
would restore her nervous and mental equilibrium. Her 
baby was admitted with her, as she was nursing it. It was 
then necessary to make some provision for the children, as 
they could not stay in the house alone, nor were the neighbors 
able to care for them longer. They had done much for the 
family the past few months. The boy was sent temporarily 
to the detention home, one of the twins to the children's home, 
and the other one to the hospital, as she was not well. Through 
some Italian neighbors it was learned that Mr. A. had been a 
hard drinker and very abusive to his wife, not providing the 
necessities of life for the family, and the house was destitute of 
furniture. He had threatened the life of his wife, and she 
lived in constant terror of him. She was a devoted mother 
and a good home-maker until the brutality of her husband 
divested their home of all the elements which make for happi- 
ness and comfort. Rest from care and responsibility did not 
bring about the improvement that was hoped for, she became 
more disturbed mentally, and the doctor thought it was best 
to have her transferred to the State Hospital for the Insane. 
The social worker filed a petition for her hearing in the probate 
court, and the judge came to the hospital to take the testimony 
and have commitment papers made out. The next day she 
was taken to the State Hospital. It then became necessary 
to make some more permanent disposition of the children. 
They were all declared dependent in the juvenile court and 
committed to the Children's Home. The social service depart- 
ment being the only agency handling the whole family problem, 
it was agreed by the judge that the children should be held by 
the home until it was determined whether or not the mother 
would recover so as to be able to return to care for them, and 
that the social worker should keep informed of her condition. 
The superintendent of the State Hospital was made acquainted 
with the social problem involved, and letters were received at 
intervals from him. No favorable report came from her, but 
she gradually grew worse, and died at the hospital a year and 
a half after being admitted. As will be seen by the accompany- 
ing pictures the children are beautiful, attractive children, and 
they have displayed good traits during their stay in the home, 



38 



" THE HOSPITAL AS A SOCIAL AGENT " 



so there has been no difficulty in rinding suitable homes for 
them since the mother died. After the mother was removed to 
the State Hospital, an Italian man who had been a neighbor 
and friend, found in a trunk at the house two bank books, one 
belonging to Mr. A., showing a balance on deposit of $200 and 
over; the other one, Mrs. A.'s, with the last item a balance 
checked over to her husband. This is only one link in the sad 
story of this little woman whose life was wrecked by the 
brutality of the man she had bound herself to. 



Elizabeth 

The following case demonstrates the hospital social work- 
er's opportunity for service. 

March 28/14. Patient was brought to the hospital about 
midnight in an intoxicated condition, having cut her arm on 
a beer bottle, severing the flexor tendon and ulnar nerve, 
and bleeding profusely. She remained in a drunken stupor 
the following day. 

March 30th. Interviewed patient. Find that she is a 
domestic in the employ of Mrs. O.; has been there one year; 
earns $4.00 a week. Her parents live in a suburb of the city, 
and she thinks she can return to Mrs. O. 's when she leaves the 
hospital. 

Later: Interviewed Mrs. O. when she came to the hospital 
to see Elizabeth. She says that the patient cannot return to 
her house. She is a bad girl, immoral and dissipated. Mrs. O. 
has allowed her to remain, thinking she might be able to do her 
some good, but there are small children in the family and she 
cannot run the risk of her influence with them. Mrs. O. states 
that on the night of the accident Elizabeth was out with a 
married man in company with others of the same sort. They 
were all drinking, and when well under the influence of liquor, 
as they walked along the street, she stumbled and fell, breaking 
a beer bottle which she was carrying, and made the ugly wound 
she had. She was first taken to her home, and her people sent 
her with the man to Mrs. O's. The latter saw that Elizabeth 



ELIZABETH 



39 



needed medical attention at once, and she insisted upon the 
man's taking her to the hospital. Mrs. O. says the wife of the 
man is very angry with Elizabeth, and if she is allowed to 
come to the hospital to see her a disturbance will be created. 
The woman will be barred from visiting the patient. 

Mrs. O. asks if this case might not be taken up with the 
proper authorities, to place the girl where she will not be a 
menace to the community, as she feels that she is either de- 
fective or delinquent. The social worker promises to talk 
with the probate judge, and see if there is not some State 
institution where she may be committed. 

March 31st. Called upon the judge, and stated the case 
to him. He says there is no State institution that will take 
her, and he is unable to do anything unless she can be adjudged 
insane. He advised seeing the chief of police. Called upon 
the chief, and he stated that the girl had violated no laws and 
there was no cause for her arrest. 

April 1st. Through the C. O. S. found that Mr. B., who 
conducts a mission in the neighborhood where her parents 
live, knows Elizabeth very well, and also knows the lack of 
sympathy and help in the home. He was called and came to 
see her at the hospital. He found her quite penitent and ready 
to promise that she will lead a different life when she leaves the 
hospital. The outcome of the case is as follows: Mr. B. 
talked with the family, pointing out their duty toward the 
girl at this time, and told them she could turn over a new leaf 
if they would give her their support. He asked their co-opera- 
tion in his efforts to place her in surroundings that would help 
to uplift as soon as she was discharged from the hospital. A 
sister who lived just outside of town offered her a home until 
she was entirely recovered, and then Mr. B. found her a place 
to work in a family where she would be kindly treated and 
helped in the upward road. Although it is three years since 
the accident, she has not retraced her steps, but has gone 
steadily on in the better life. She is now a respected member 
of the community in which she lives, active in the little church, 
and is planning to marry a man who has passed through 
much the same change that she has. 



CHAPTER V 



SERVICE TO THE INDIVIDUAL, TO THE COMMUN- 
ITY, AND TO SOCIETY 

1. The Tuberculous Patient. 

2. The Epileptic, Insane, and Feebleminded Patient. 

3. The Problem of the Unmarried Mother. 

Much stress is laid on the responsibility of social workers 
in their service to the individual, to the community, and to 
society; this is the tripod of efficient work. Each foot of the 
tripod is equally important, as each carries an equal share of 
the whole burden of humanity's welfare. Work accomplished 
in one direction is a benefit to the whole because of the close 
interrelation. The relation of the individual to the com- 
munity and to society, and the maladjustment of this rela- 
tionship through the reactionary influences, is the cause of the 
many and varied social problems. 

One cannot live wholly apart from society, as is well illus- 
trated by the life of a hermit, who, after years of separation, is 
suddenly thrust upon the community by means of sickness, 
accident, or death as a real social problem. The kind of life 
an individual lives has its influence upon society, and con- 
versely the good or bad in society affects the life of each indi- 
vidual member. Each person is a part of the community and 
of society, with his responsibilities and moral obligations, and 
the members of society, as a whole, are deeply responsible for 
the influences which surround the individual. We are "our 
brother's keeper," and we cannot escape this responsibility. 
It is not necessary for us to engage actively in service to fulfil 
4 o 



THE TUBERCULOUS PATIENT 



41 



our obligations; our habits and every-day actions speak to the 
world for good or evil. The solitary life of the recluse has its 
influence as truly as that of the man who figures prominently 
in the courts. 

So the life of the individual ramifies into the life of the 
community, making the warp and woof of society, and, like 
the finished cloth, the texture exhibits the quality of the 
threads which are woven into the fabric. As members of 
society, then, we are gravely responsible for each individual, 
both personally and in so far as we allow conditions to exist 
which are deleterious to the life of the community. 

Social workers should keep in mind this tripod of efficiency 
as their standard and base their case work upon it. Do not 
follow out the lines of least resistance or dispose of a case in 
the quickest way, as this habit tends to narrow one's ability 
to do effective work, or else it leads to a desire for numbers 
rather than efficiency, and social work can never be estimated 
in numbers. 

This threefold responsibility is demonstrated in the three 
classes of cases with which the hospital social worker comes 
in contact: the tuberculous patient, the epileptic, insane and 
feebleminded, and the unmarried mother. 

1. The Tuberculous Patient 
From the standpoint of sickness, physical suffering, and 
death there is probably no other medicosocial problem that 
carries with it into the community more serious results, and 
consequently calls for more intensive work, than that of the 
tuberculous patient. Further, with the exception of the vene- 
real problem, no other presents such difficulties in the way of 
solution. Recognizing as we do that both tuberculosis and 
venereal diseases are preventable, we realize that medical 
treatment, prophylactic measures, education, and social re- 



42 



" THE HOSPITAL AS A SOCIAL AGENT " 



adjustment are the factors which make up the armed force to 
combat these diseases. The tuberculosis problem has made 
gratifying headway in spite of its enormity, yet it is far from 
being solved. The results of this disease are so apparent, so 
open; its spread, its suffering and death so appalling, that the 
whole mass of people have been made aware of its dangers 
and have readily enlisted in the fight against it. The diffi- 
culties in the way of an adequate solution of the venereal 
problem are more insurmountable because of a more or less 
marked secrecy which is maintained by persons afflicted with 
syphilis or gonorrhea, and because it is so acutely involved 
with the evil which is responsible for its existence in the com- 
munity. It is only in recent years that publicity has laid bare 
the real facts regarding the extent of venereal disease and its 
awful consequences. People are only beginning to be educated 
in this direction, and there can be no successful campaign 
inaugurated without first a universal plan of education. The 
enormity of the problem and the huge difficulties in the way 
have not yet ceased to stagger workers and inhibit their 
activities, for at every turn an insurmountable wall looms 
up before them. In setting aside this problem for that of the 
tuberculous patient we do not regard its dangers as less, but 
the present outlook for the great white plague as more nearly 
ripe for substantial results. 

Whatever the community's facilities are for caring for 
tuberculosis, the social worker should keep in mind the prin- 
ciples which govern the treatment of the disease and the ele- 
ments which make up the danger to others. Very few com- 
munities are prepared to meet in an adequate way the needs 
of this problem, cases are not discovered until they are too 
far advanced, patients are dying in the homes and infecting 
other members of the family; hospital and sanatorium facili- 
ties for the care of incipient cases are unequal to the demand, 



THE TUBERCULOUS PATIENT 



43 



and our hands are so far tied. However, we know that a be- 
ginning case has every chance to recover if he can have fresh 
air day and night in abundance, good, nourishing food, mod- 
erate exercise, and cheerful surroundings. He must use cer- 
tain precautions for his own sake and for the sake of others 
in the family. This routine intelligently carried out, and 
the patient kept under supervision of a physician, either 
private or dispensary, may bring about very satisfactory 
results in the home without removing him to a sanatorium. 

We recall the case of a young boy, fifteen years old, whose 
treatment was supervised from the dispensary. Someone 
interested in him provided a tent which was pitched in his 
own yard, where he slept even in the coldest weather. One 
night the wind blew the tent over, but he set it up again and 
continued sleeping there, for he knew it meant life to him. 
A little nephew in his home attended kindergarten, and he 
took him each day to and from the school, thus getting a 
proper amount of exercise outdoors. Then he secured a few 
pigeons and built a house for them, and this afforded occu- 
pation for him. Returning regularly to the dispensary he 
was weighed each time, gaining steadily, and improving in 
every way. The following summer he went to the country, 
where he was doing well at last accounts. 

After the fresh-air treatment was accepted as curative, 
and before special sanatoria were built, tents were pitched 
in yards, porches were enclosed with screens, beds were put 
on the roofs, windows were extended, any outdoor corner 
was arranged for the patient to sleep, and even in the crowded 
cities good results were obtained. Reference to some of the 
early reports of social service work in hospitals will show how 
extensively this was carried out and what the results were. 
In these later days, since special institutions have become 
more abundant, we have too easily fallen into the habit of 



44 



" THE HOSPITAL AS A SOCIAL AGENT " 



thought that all cases must be removed from the home to a 
sanatorium for effective treatment. The facts are, institu- 
tions are always full, and the number of beds available falls 
far short of meeting the demands, and it behooves social 
workers to save these places for patients who cannot be cared 
for successfully at home, or where they are a danger to young 
persons or children in the family. There may be other social 
reasons why the home cannot be utilized; all these should be 
taken into consideration before deciding where and how the 
patient should receive the treatment. One advantage to be 
gained from the sanatorium care is the training which patients 
receive in prophylaxis, and if there is a degree of intelligence 
to grasp this, much good is done in the way of education. 

If it is possible to establish in connection with the tuber- 
culosis clinic a broad, comprehensive program, such as has 
been followed out in Bellevue Hospital, New York, the re- 
sults will be found much more satisfactory. The dispensary 
should be made the examining agent at least, and the dis- 
ease may thus be detected in its beginning stage when proper 
treatment can be inaugurated. Or, if cases are advanced, 
they may be placed where they will not be a danger to others. 
Again, having access to all the special clinics and the laboratory, 
x-ray, and hospital wards, there is opportunity for careful 
diagnosis and treatment of complications. 

The educational phase of the work with tuberculous 
patients has not been developed in dispensaries as extensively 
as it should be. The chief reason is the lack of a sufficient 
force of social workers to carry out such a plan. But it is a 
most important measure in the fight, as it is possible to reach 
in groups those who are the carriers of infection, and so to dis- 
seminate the knowledge of prevention from a most impressive 
source. Classes for instruction upon the principles of the 
treatment, upon the technic of precautionary measures, 



THE EPILEPTIC, INSANE, AND FEEBLEMINDED PATIENT 45 

upon the importance of cheer and hope, and the teaching 
by graphic posters the many sources of danger; these are 
features of the educational work. This important aid in pub- 
lic health work will be spoken of in another chapter. It is 
only necessary to visit the special tuberculosis clinics where 
intensive, well-organized work is carried on to be convinced 
of the opportunities for most effective service. Our plea is 
for its introduction into the smaller dispensaries where re- 
sults differ only in degree. 

2. The Epileptic, Insane, and Feebleminded Patient 

One of the greatest responsibilities of social workers to 
the individual, the community, and society is the disposition 
into proper channels of mental defectives. It would seem as 
though this were so self-evident a fact that there need not be 
much said, and this is true where the condition of the patient 
is so dangerous that immediate steps must be taken to safe- 
guard all concerned, but with the milder types of defectives 
there is a tendency to leniency when the question of cus- 
todial care arises. It is a well-established truth that all mental 
defectives are a menace to society unless they can be guarded 
and controlled, if not in the home, then in an institution. 
The detection of the milder types of mental disorder is, there- 
fore, most important, and this may be more easily done in the 
hospital and dispensary, as patients are under more constant 
observation than otherwise. It is sometimes difficult to dif- 
ferentiate closely enough between insanity, feeblemindedness, 
and epilepsy to decide which is the proper institution for the 
patient. Where a psychopathic ward is available in the com- 
munity it serves as a clearing-house and should be used as such, 
entrance to a State institution being more easily secured 
through its specialists. 

In justice to society, the mental defective should have 



46 



" THE HOSPITAL AS A SOCIAL AGENT " 



proper attention; those who are in condition to be a menace, 
or whose home surroundings are unfit for adequate super- 
visory care, should be placed in an institution, and those 
who are amenable to medical treatment should be given 
every opportunity for readjustment and improvement. 
Clinics for nervous and borderline mental cases are of won- 
derful value in the community, especially when the doctor's 
work is supplemented by that of a social service nurse who 
investigates the home conditions and surroundings, and helps 
in the patient's readjustment in the home. 

The work which is being done by a number of the States 
through a well organized mental hygiene society or committee 
is keeping many a mental case out of the State Hospital, and 
helping many more to return to their homes and remain well 
because of the efficient social service rendered. These societies 
have been the means of establishing mental clinics attended 
by specialists, and of placing there a nurse with experience 
in mental diseases to visit the home and learn the contribut- 
ing causes of the breakdown. If there are readjustments 
either in the home or with the patient, the nurse may render 
very valuable assistance. These clinics sift out the cases that 
are amenable to treatment from those which are a positive 
menace to society and make possible adequate medical or 
social care. What a service to the individual and to the com- 
munity when people are thus returned to their place in the 
life and work of the world! 

On the general hospital wards there will be found the 
occasional case of insanity following a fractured skull, or a 
postoperative mental disturbance, or a case of paretic demen- 
tia, where the physical symptoms have been of such a nature 
that mental symptoms were obscured or unnoticed until the 
patient was under more close observation in the hospital. 
The epileptic insane drift into the hospital as emergency 



THE PROBLEM OF THE UNMARRIED MOTHER 47 

cases, and the wandering types of insanity find their way there 
because they can so readily assume physical illness. Cases 
of hysteria prove to be a great deal of trouble and annoyance 
on the wards, and are sometimes hard to get rid of, as they 
develop some very convenient and seemingly serious symptoms 
when told they may be discharged. 

The social worker has a definite responsibility with these 
patients, and should not allow them to be sent out into the 
community without at least making an effort to place them 
in the right channels. It is often difficult or impossible to 
carry out adequate plans, owing to opposition by patient or 
friends which cannot be overcome, but the worker has not 
done her full duty until she has made every possible effort 
to serve the individual and the community in an adequate 
way. The responsibility goes back of the social worker to the 
hospital physician, upon whose medical opinion the social work 
must be based. It is a true but unfortunate fact that gen- 
eral practitioners, many of them, neither recognize the mild 
types of mental disorder nor the real import of the social 
problem involved; they are more or less indifferent to the 
danger of the presence of these patients in society. We can- 
not help feeling, however, that these same doctors may be 
educated to a realization of the importance of this question 
by the tactful efforts of the social worker. Her responsibility 
is, therefore, twofold, but we believe she is equal to it if she 
can be awakened to its importance. 

3. The Problem of the Unmarried Mother 
The unmarried mother who finds herself in the hospital 
is introduced to the social worker at the crucial time when 
her problem becomes a vivid reality, and she must decide 
which course she will take, whether she will follow the path 
of duty or her own inclination to cover up one sin with another. 



48 



"the hospital as a social agent" 



It is a crucial time also, because the mother instincts are most 
delicate and keen, and may be nurtured into maturity to 
help the mother in her decision for the right. Unless the girl 
is wholly unfit physically, mentally, or morally to rear her 
child, the mother and baby should not be separated; this is 
the rule from which we should not deviate except under ex- 
tenuating circumstances. All the influences should be focused 
at this time upon this one course, nurses and doctors insisting 
upon her nursing the baby, and social worker encouraging 
her in her duty and securing assistance to help her carry it 
out. It almost always appears to the girl that it is impossible 
to follow out the plan suggested, and she has previously made 
up her mind that the only thing to do is to give the baby away, 
because she does not wish to face the disgrace before the world, 
and because she thinks she cannot care for her baby and at 
the same time support both. Then the family, if they are 
aware of the circumstances, prefer the "cover-up" method 
in their effort to save the girl's disgrace and that of the family. 
They do not realize that "murder will out," and when it does, 
it brings much more disgrace because the double sin is now 
trebled. 

The girl should be impressed with two things, namely, 
that she is not altogether blameless in this situation, so is 
responsible for her part in the care of the baby, and that it is 
possible for her to take care of her baby and support both. 
The mother's duty is to follow nature's own way of nourishing 
her offspring, nurturing and giving to it the best she has, in 
order to establish a physical foundation which will insure a 
strong child, able to meet life as he should. The first weeks 
and months of the life of a babe are critical ones; if he can be 
safely carried through these he has a better chance in life 
than if he is deprived of his mother's care. This in itself 
should be sufficient argument to make the girl decide to keep 



THE PROBLEM OF THE UNMARRIED MOTHER 49 

her child no matter what it costs her. The charge of child 
abandonment is a serious one for a girl to face, much more 
serious than the lesser disgrace which she thinks she cannot 
face before the world, and rescue homes of all kinds and de- 
nominations are refusing to separate mother and babe because 
they realize the serious results to both from this procedure. 
The girl is responsible for the life of the child, and she should 
be deeply impressed with this fact from the first. At the same 
time, her mother instincts must be appealed to, and the joys 
and blessings which are sure to come from association with 
the child, as well as the satisfaction which results from duty 
fulfilled, should be earnestly set forth. Say to her, "How 
can you give up your baby, your own flesh and blood? How 
can you throw your innocent child upon the world to face 
the disgrace that you wish to avoid? How can you deprive him 
of both father and mother?" Show her that her friends and 
the world in general will respect her more for holding to her 
duty, and that she will be happier for doing it. 

The following letter, written by a girl seven months after 
her baby was born in the hospital, shows the result of this 
course pursued. 

"Dear Friend: Your welcome letter was received some 
time ago, and I wish I could tell you what a bracer it was. 
I have not worked for two weeks; have been very sick with 
grip. I still have a very bad cough. The doctor was here 
twice and I went to his office once, then I caught more cold. 
Baby Helen is quite well just now, with the exception of two 
sore fingers, Mamma says comes from her teeth, although I 
have seen no signs of a tooth yet. She is getting so noisy now. 
I do not know what I would do without her now, as my whole 
life seems to be wrapped up in her. I never realized I could 
love a little baby so much. Without her I do not know what 
I would do, for when I get tired or downhearted and stop to 
think of her, I take up my burden with renewed energy, and 
4 



50 "the hospital as a social agent" 

then it is a comfort to me to know that I am not the only one 
who is traveling this same road. I get a letter from a girl 
friend of mine in the city every now and then that always 
gives me the blues, she is always telling me what the other 
girls are saying, so I wrote her not to write any more. The 
girls who were true friends of mine I still have and the others 
I don't want. Her letters did me more harm than good. 
Well I will have to close now. Write again soon for I can 
hardly wait till I get your letters open to read them. Trusting 
you always, your friend." 

The morning after her baby came the social worker, talking 
with her, asked her what she planned to do. As was expected, 
she said she thought she would have to put the baby some- 
where and go to work, that she did not want her parents to 
know of her trouble, for they were not able to help her, and 
she knew her father would be very angry with her. Her 
duty to the baby and the possibility of getting work in a 
private home when she was strong enough was presented to 
her as a better plan, and she was left to think it over. When 
the worker visited the ward on the following morning she 
was greeted with a bright smile from this girl, and her first 
words were, "I have been thinking about what you said yes- 
terday, and I have decided to take your advice." Such good 
news was most gratifying, and immediately the social worker 
began to plan for the consummation of this purpose. Corres- 
pondence with her mother living in a nearby town was be- 
gun, the girl's pastor was called, and his interest and help 
solicited. He knew the relatives in town and got in touch 
with them. They came to the hospital to see her, and an uncle 
offered her shelter until she was strong enough to work. 
The visitor from the Associated Charities called to talk about 
a suitable place for her to work where she could have her 
baby. When she left the hospital she went to her uncle's 
for two weeks, then a good place was found in a home where 



THE PROBLEM OF THE UNMARRIED MOTHER 5 1 

there was an invalid wife. The family became very fond of 
the baby, and they appreciated the good work done by the 
girl; the baby kept well and was devotedly loved by the 
mother. Upon the death of the wife in the home it became 
necessary to find another place, but the girl faithfully and 
contentedly stuck to her duty. In the fall it seemed best for 
her to go to her own home, where her mother and father re- 
ceived her with open arms, and soon the baby won her way 
into the hearts of all the family so they would not let her go. 
This girl is experiencing the joy and satisfaction of duty done, 
her compensation is the bond of love between herself and the 
child, which is strengthening every day, and she is happy 
when she looks at Baby Helen, to think she did not cast the 
innocent one upon the world to fight her battle alone. 

Regarding the father of the child, with him the hospital 
social worker has little to do, her problem is the immediate 
question of the care of the mother and babe, and making 
provision for them when they leave the hospital, and she has 
her hands full if she accomplishes this successfully. But he 
should not be disregarded altogether, as he is a guilty party 
in the situation, and has his share of the burden which he 
should be made to carry if it is possible to bring him to it. 
If marriage is a reasonable solution at all, this is the best 
advice to give; if not, some means should be sought to rind 
him and secure support for the mother and child. This is a 
matter for personal consideration, as marriage might be the 
most disastrous thing to all concerned, and the publicity 
to which a girl is subjected by bringing the man into court is 
sometimes more harmful than beneficial. This whole question 
of the man in the case is best turned over by the hospital 
worker to an outside agency, as it is usually involved, and 
calls for follow-up work for some time. 

The province of the hospital social worker is to start 



52 



" THE HOSPITAL AS A SOCIAL AGENT " 



things moving in the right direction, to put the case in the 
right channel to accomplish just service to the individual, 
to the community, and to society. Whether this is brought 
about by marriage, by return to the home by reconciliation 
with the family, by placing out in a private home, or by sending 
the mother and babe to a rescue home for the usual allotted 
time, must be determined by circumstances. In the case of an 
irresponsible girl or woman, especially if it is her second offence, 
it may be best to separate mother and babe, placing the mother 
in a proper custodial institution and the baby in the hands of 
a child-placing agency. Each case must be decided upon its 
own merits, as it rests on our tripod of efficient service. 

Two rather unusual cases of unmarried mothers may be 
cited here. 

FOURTEEN-YEAR-OLD JANE 

Jane was admitted to the maternity ward of the hospital a 
few days before she was to be confined, and the social worker 
became acquainted with her at this time. She was but four- 
teen years old, a mere child. Her attitude was that of in- 
difference to the situation which she was facing, she seemed to 
feel that it would be an easy matter to get rid of the baby and 
return home again as free as before. Her parents were re- 
spectable people, entirely out of the dependent class, but at 
this time needing the most tactful assistance in the social 
problem they were going to be obliged to meet and solve. 
When the mother came to see the girl the social worker talked 
with her, and found much the same feeling that the girl pos- 
sessed. She stated that her husband must not become ac- 
quainted with Jane's real condition, for he was a very high- 
tempered man, and she feared what his anger would lead him 
to do. She knew the truth would entirely upset him. The 
girl's duty in the matter was presented plainly to the mother, 
and she was urged to help follow out the right course, going to 
her husband, and telling him frankly of the trouble. Their 
effort to keep the real facts from their friends would be futile, 
and it was better to face the situation in an open, just way, 



FOURTEEN- YEAR OLD JANE 



53 



giving their daughter the support she needed now more than 
ever before. The mother claimed that she had tried to watch 
Jane in every way to prevent trouble of this kind, and she did 
not understand how it could have come about. The first day 
of her interview with the social worker she went away in tears, 
but the next day returned with smiles, for she had told her 
husband, and the storm that she expected did not come. 
They were willing to follow the advice given, and stood ready 
to help in any way they could. Jane's father called on the 
social worker to talk over the plans, and broke down with 
emotion during the conversation. It was suggested that Jane 
go out of the city with her baby when she was ready to leave 
the hospital and stay at a refuge home, where she would learn 
to care for her baby and to do many of the things which are 
necessary in the home. This was agreed to, and the transfer 
was successfully made. In the course of the investigation 
the boy who was responsible was found, though, much to our 
surprise, it was difficult to attach the right one. According to 
his statements he was not the only boy who might be impli- 
cated. He belonged to a good family, and his father had a 
prosperous business, in which his son, then seventeen years of 
age, was receiving training for his life-work. The boy at 
once expressed a willingness to do the right thing by Jane, and 
his parents also took a most sensible view of the situation and 
promised support. A most unique situation thus existed, 
where the parents on both sides stood ready to help, and by 
coming together and talking things over they agreed upon the 
best plan for both the boy and girl. On account of their 
youth they were neither of them mature enough to establish 
and maintain a home, so it seemed important that Jane should 
spend a year at the rescue home, where she would have the 
training and discipline she needed, and she courageously ac- 
cepted her duty. Before she left the hospital she had learned 
to love the dear baby, and nothing could have persuaded her 
to give her up. Bringing the mother and father of the baby 
together, as social investigation and work on the case had 
done, served to foster a growing attachment between them, 
and they pledged their troth before Jane left for the home. 
Only a short time passed before the boy-father realized how 



54 "the hospital as a social agent" 

much he loved the girl-mother and the baby as well, who ap- 
pealed to him as a fatherless child. He determined to have 
them both and make the home for them. His parents were 
willing to share their home and her father and mother to assist 
with the family expenses, so Jane returned to the city, and they 
were married in an Episcopal chapel in the presence of the 
immediate relatives. It was the privilege of the social worker 
on the following Sabbath to act as godmother when the baby 
was christened. When a visit was made a year later they 
were living happily, the father had finished his apprenticeship, 
and was receiving regular wages. It is granted these two were 
not mature enough to marry and undertake the responsibilities 
of parenthood and of establishing a home, but with the support 
and guidance of the parents of both was it not best under the 
circumstances to assist in bringing this about? 

Florence and Her Twins 
One day in January the hospital office called the social 
worker's attention to a woman in the maternity ward who was 
about to be discharged, but who seemed to have no place to go 
with her twin babies, and neither did she have money to pay 
the hospital bill, as she had promised when she was admitted. 
Because she was a paid case she had notbeen interviewed before 
by the social worker. So it came about that at this late day the 
worker was presented with Florence and her twins, and it was 
found that Florence was not married, did not know where she 
could go, nor what to do with the babies. Furthermore, she 
had no money to pay the hospital bill, as some friend she 
thought she could rely upon to furnish the money did not ap- 
pear, and Florence had no definite address with which to reach 
her. This poor woman was evidently under par mentally, 
this was her second offence, she having a girl seven years old 
staying with some people in the city. She had worked at a 
hotel until a short time before coming to the hospital, so had no 
home to go to. The people who were keeping the girl would 
have nothing to do with Florence if she kept the babies, and it 
was no place for her, as they were poor and dirty. As usual, 
the only thing that seemed could be done was to give the 
babies away and go back to work, but, of course, she was 



FLORENCE AND HER TWINS 



55 



dissuaded from this thought, and the better plan was presented 
to her, with assurance of help to follow it out. Commitment 
through the city charities to a nursery where she could take 
care of her own babies was secured, and the transfer was soon 
made. Here she found a friend in the superintendent, who was 
a good, motherly, wise woman, and probably for the first time 
in her life she received the uplifting encouragement that showed 
her there was another road to travel better than the one she 
had followed, one with greater rewards and more happiness, 
because it was the right road. Florence learned to love and 
tend her babies, and to be helpful about the nursery, so as we 
visited her from time to time we found her very happy and 
contented. She had no desire to go out nights, she stayed 
close to her duty, and as time went on she was given more 
general work to do and soon became indispensable to the 
house because she proved herself faithful and reliable and 
efficient. For a year and a half that we were able to keep in 
touch with her she was happy, contented, and useful. This 
story would not be complete without relating the close call 
that Florence had to being sent to the State Reformatory 
because of her seeming irresponsibility due to her feeble- 
minded condition. The public commissioner determined that 
there was no use in expending public funds to support a woman 
who had no moral sense, and was bringing babies into the 
world at the rate of two at a time for the community to take 
care of. A warrent was issued for Florence's arrest on a 
charge of dependence. The poor woman was brought to the 
city jail the night before the time set for trial, leaving her 
babies crying for food, and she herself suffering the discomforts 
of engorged breasts. When she appeared in the court room 
she was frightened and bewildered, and did not know how to 
answer the judge's questions. The court's decision was soon 
made that she should be sent to the State Reformatory. Just 
at this point the police matron appeared with a message from 
the superintendent of the nursery, asking that Florence be 
given six months' probation and left at the nursery, as she had 
already shown an improvement, and they were glad to do all 
in their power to help her in the upward road. The judge 
granted this request, and Florence was returned to the nursery 



56 " THE HOSPITAL AS A SOCIAL AGENT " 

a happy woman and warmly greeted by her babies. The 
commissioner was the unhappy one after this because he had 
not accomplished his desire, and he consoled himself by with- 
drawing the city support for Florence at the nursery. She 
was retained, however, at their own expense, and in time 
earned not only her own board but was given wages. While 
it is granted this woman was mentally weak, and in so far irre- 
sponsible, the results justified the trial she was given to make 
good, and the good influences thrown about her were as ef- 
fectual as the evil ones had formerly been. She was just weak 
minded enough to be influenced either way, but why should 
she not be given the chance to find her place in the world when 
she displayed the ability for good work that she did? 

Both of these had their far-reaching influence in the com- 
munity, which will be readily recognized, and society was 
benefited, as it always is, when these girls are taught to pro- 
tect themselves and others against a repetition of the same 
offence. The baby is a tie which holds the mother. If she 
is relieved of her burden, it falls upon the community, and 
leaves her free to travel the same road again and add another 
burden. It is not an easy road for the girl, for she finds her- 
self alone in the midst of difficulties and perplexities which 
are naturally shared with the partner, and for this reason 
she should have the encouraging, uplifting, helpful influences 
and surroundings to hold her to the path of duty. 

One factor is important in these cases which we must not 
lose sight of. Remember that we are dealing with the result 
of one of the strongest of human passions. This thought 
should modify our first natural feeling of disgust, and the 
tendency to attach merciless blame to either party concerned. 
God has endowed man with this passion, and made it an 
overpowering, ruling one, that the race may be preserved to the 
end of time. This passion is the impelling force in all of man's 
activities, and nature demonstrates that the stronger this 
impelling force is, the greater are man's activities. It is the 



THE PROBLEM OF THE UNMARRIED MOTHER 57 



power that moves the world. Nature proves that all things 
that have life possess the power of reproduction, and the con- 
stant struggle is to preserve life through this power. In man 
only has the Creator placed a censor for the control of this 
power by the use of the will, and just so far as man recognizes 
his moral obligation and lives up to the rules and customs of 
society this censor will keep him within the bounds of what 
we term "right living." However, "right" is a relative term, 
who can define it absolutely? Our standards are high com- 
pared with those of some others who are constantly thrown 
into temptation, and it is easier for us to maintain our high 
standard than it is for those others to resist the promptings 
of this powerful impulse in the midst of temptations to uphold 
a standard that is lower. 

There are others who have no moral standard, and who 
recognize no moral obligation. They do not fall, they are 
only following nature's impulses and demands, scarcely know- 
ing that it is a sin to yield to these impulses indiscriminately. 
Another class know what their moral duty is in this respect, 
and, as a rule, fulfil it, but temptation comes, the impulse 
is stronger than the will, and the censor is removed. This 
group furnishes many of the cases with which the hospital 
social worker in the smaller communities comes in contact, 
and her sympathetic, tactful handling of them is sure to 
spare many a good, right-meaning girl from social ostracism 
or from drifting into a life of degradation. 

In dealing with the unmarried mother in the hospital ward 
we must accept her in her present situation, determine what 
her moral standards are, and what should be done for her 
best good and for the good of the community and society. A 
good religious influence is important with many of these 
girls, but if we try to make it a panacea, we lose sight of the 
different types of girls and of the causes, within and without, 
which bring about the unfortunate results. 



CHAPTER VI 



THE PROBLEM OF THE HOSPITAL CHILD 

The children's ward is one of the most interesting places 
in the hospital. Because of the child's helplessness and de- 
pendence he always finds a benefactor when in need, but the 
sick or injured child especially calls forth universal sympathy. 

The children's ward is interesting to the social worker 
because of the varied problems of vital importance which are 
offered for solution. The recognition of a lifelong handicap 
through disease, deformity, or injury calls forth far-reaching 
sympathy, which outweighs pity for present suffering and 
leads to intensive work for the welfare of the child. Our 
little Baltomero, whose story is recorded on page 62, suffered 
for weeks from the many operations he underwent to make 
for him better hands, but how little did that count compared 
with the deleterious effects of dependence resulting from such a 
handicap as his? This child was one of the bright spots in the 
experience of the worker. He was so lovable and showed 
signs of such a bright mind it was a joy to receive his greeting 
each day on the ward, and to know that there was opportunity 
for lasting service to him. 

The encouraging feature of the work with children is the 
advantage to be gained by early service, and the opportunity 
for prevention which is thus afforded. This fact, coupled with 
a natural interest in children, furnishes an incentive for real 
active work. Take the six children on the car who were snap- 
ped while on their way to the roof garden, they are all tuber- 
58 




Fig. 4. — A group from the children's ward. 




Fig. 5. — On the way to the roof garden. 



THE PROBLEM OF THE HOSPITAL CHILD 



59 



culous or syphilitic. How important that their treatment 
should be started now and continued until they are well. 
Annie's open sinus and Angeline's may be healed if taken 
in time. Gisella's tubercular hip needs attention before the 
disease gains headway. Josie and Barbie with rachitic legs 
may be helped by treatment now while the bones are soft. 

All of these children were greatly benefited by their hos- 
pital care, and the social service rendered is beyond question. 
It required a great deal of encouragement and persuasion 
and friendly advice on the part of the worker to hold them until 
the medical and surgical work could be completed, and in the 
case of Angeline, whose story is coupled with that of Mary 
(page 63), she became a real social problem. 

It is sometimes necessary to institute court proceedings 
against the parents in order to obtain for the child the hos- 
pital care which is necessary to save him from being an un- 
fortunate cripple. This is not resorted to, of course, until 
all other methods of persuasion have failed. 

A two-year-old girl, with a corneal ulcer which was the 
result of the parents' neglect to give her proper care, was 
obliged to lose the eye because it had ruptured. The infec- 
tion would have extended to the other eye if the diseased 
one had not been removed, and total blindness would have 
resulted. No amount of persuasion or threatening moved the 
parents to consent to the removal of the child's eye, so it was 
necessary to bring them into juvenile court for neglect. The 
judge issued orders for Eva to be retained in the hospital as 
long as it was necessary, and the doctor was permitted to 
carry out the treatment which, in his judgment, would pre- 
vent blindness. 

The story of Charles on page 64 illustrates the necessity 
at times of asking for the help of the court to obtain treat- 
ment that preventive measures may be carried out. 



60 " THE HOSPITAL AS A SOCIAL AGENT " 

It is the duty of society to protect the innocent, helpless 
members, and this duty is performed partly in self-defense. 
The strong are responsible for the weak, and if children are 
in danger of becoming the victims of the ignorance and stub- 
bornness of parents, the better members of society who are 
capable of recognizing the danger signals should serve as the 
children's defense. Parents have their rights, but individual 
rights and those of society must take precedence in a critical 
moment. 

Lest the overzealous worker in the small community 
should be led into error through a misuse of this idea of duty, 
it must be repeated that the court is a last resort. Sometimes 
the sacrifice of one child will strengthen the cause of all others 
to follow, and a misdirected plan to force parents may be the 
means of losing their confidence, and the social worker loses 
her opportunity for valuable service. 

The greatest wisdom and foresight is necessary in handling 
many of the acute problems. It is a terrible thing to see a child 
suffer, and to know that it is innocently bearing the pain 
inflicted by someone who is either ignorant or evil. But the 
wrongs may not all be righted in a day, and it is the ultimate 
good to the greatest number that must determine the best 
methods of procedure in individual cases. Many things 
must be taken into consideration. Parents are prejudiced 
by their love for the child, and although it may be more of an 
animal love than human it must be recognized, and often the 
best way to win them is to gain their confidence by taking 
their point of view. Then, parents have their rights, and 
those rights are just, as far as their responsibility goes. Ig- 
norance may be due to superstition which influences them, 
and superstition is very hard to overcome. Again, we must 
be able to answer the question, What method of action will 
gain our point or bring about the best results? 



THE PROBLEM OF THE HOSPITAL CHILD 6l 

Sometimes our hands are tied, and it is impossible to ob- 
tain the co-operation from other agencies to properly place a 
child for care when he leaves the hospital. This was the diffi- 
culty with little Mary who is pictured with Angeline. It 
may be, pressure enough cannot be brought to bear upon 
proper authorities to improve sanitary and living conditions 
which are responsible for the illness of the baby, and the work 
of hospital physicians is wholly undone when the child returns 
home. Indeed, there are many stone walls which we cannot 
climb over, but some day an opening will be made through 
which we may freely pass, if we continue our efforts persist- 
ently. 

If we would win in many of these difficult problems we 
must establish public confidence by the careful, practical 
handling of case work. Social workers should have definite 
knowledge of facts through complete investigation, a definite 
problem, and a definite plan of action. 

The hospital child presents such vital problems, and our 
love and sympathy play such a large part, the work receives 
an impetus which assures ultimate success with any undertak- 
ings in his behalf. The child will some day be the man, and 
service to the child is service to the man. In other words, 
disease overcome in childhood, or a strong constitution es- 
tablished through proper feeding and care of the infant, 
lay the foundation for the making of a man equal to his task 
in the world. All through his life he will be an asset in the 
community instead of a liability. This is the sum and sub- 
stance of all social work, and the work with children offers 
great opportunities in this direction. 

Just here may be mentioned an important service in the 
out-patient department, because it has to do with making 
better babies, who stand a better chance to become strong 
men. 



62 



"the hospital as a social agent" 



In small communities an out-patient obstetric service may 
be maintained through the co-operation of the district nurses. 
The prospective mother is given a complete examination 
in the dispensary, including urinalysis, and is then placed 
on the waiting register for outside delivery. The case is re- 
ported at once to the district nurses, who take up the pre- 
natal care. The patient is delivered in her own home by a 
doctor and nurse from the hospital and the district nurse 
follows with postnatal care. This plan, with slight variations, 
is in operation in a number of places, and may be handled in 
any hospital with the dispensary under social service super- 
vision. 

There is no question as to the value of such a service to 
the mothers and babies. Many of the ills which follow child- 
birth attended by midwives and careless doctors are averted; 
the danger to the baby from infected eyes is lessened 100 per 
cent., and the close touch with its accompanying influences, 
which is thus obtained for two important social agencies, 
gains an effectual vantage point. Better mothers and better 
babies must result from this kind of service, and the cribs 
in the children's ward would go begging for the poor little 
starved creatures which never had a fair start in life. 

Baltomero 

Baltomero was eighteen months old when he was admitted 
to the hospital. His parents were Italians, living in a poor 
quarter of the city in crowded rooms. Since birth he had had 
webbed fingers, and he was brought to the hospital to see if 
something could not be done to improve his crippled hands. 
The surgeon operated several times, cutting down between the 
bones that were at all normal, and making separate fingers as 
far as possible. Since the child gains much knowledge through 
the manipulation of his hands, this boy was in danger, through 
his handicap and through ignorance of the parents, of losing 




Fig. 6. — Baltomero. 




Fig. 7. — Mary and Angeline. 



MARY AND ANGELINE 



63 



much natural brain development if he did not learn to use 
these new fingers. As soon as he was old enough for kinder- 
garten he should be started there, but in the meantime he 
should be taught to handle his food, playthings, books, etc., 
and so it was essential that no time be lost. Visiting at the 
home, the mother was shown how to give him playthings of 
different shapes and forms, and the social worker took blocks 
and other things to him to demonstrate to the mother what 
was necessary. It was most gratifying to notice how his 
little, bright mind and determined spirit taught him naturally 
because there were placed before him the things that were 
attractive to him. Nothing was too hard for him to attempt 
to do. He learned to hold a spoon and feed himself with it, 
and could pick up a dime which was offered him as a bribe, 
following the much used custom of foreign parents. Realizing 
that such supervision needed to be carried on for years to come, 
the social worker felt it would be best to place the child under 
the care of a permanent agency in the community, and so the 
case was placed before the Children's Aid Society for considera- 
tion. After investigation, they agreed to assume this super- 
vision, and a visitor began regular visits to the home. 



Mary and Angeline 

The two children seen in the picture are grouped together 
because they were in the hospital ward at the same time, and 
because they are poor, dear children whom no one wants, yet 
must be cared for somewhere by someone. Both are diseased, 
Mary, on the left, having a congenital syphilitic condition, pro- 
ducing an ever-recurrent eye trouble; Angeline, on the right, 
suffering from bone tuberculosis, appearing at different times 
in different places. It will be noticed the middle finger of her 
right hand is amputated, this being done when she was but 
eighteen months of age. Mary's mother died when she was 
one year old; her father was too feebleminded to support him- 
self or even to give Mary the daily care she needed, and he 
died in the County Infirmary from cancer. With such a 
family history and such a physical condition even the Chil- 
dren's Home did not want her, the hospital could not keep her 



64 "the hospital as a social agent" 

all her life, and no one would adopt her. After two years of 
supervision and hospital care she was taken over by the State 
Board of Charities, who will see that she has all that can be 
provided for her welfare as long as she lives. Angeline has a 
mother, but she is more irresponsible than not, and has left 
Angeline to the tender mercies of others, so she might be free 
to go her way as she chose. Fully half of the time the past 
three years the child has been in the hospital, sometimes with 
three discharging sinuses. The mother finally married, and 
it has been our task to insist upon her keeping Angeline and 
caring for her, although many times she has come and begged 
to leave her in the hospital. The grandmother, who has kept 
the child much of the time, is now too old to have the responsi- 
bility, and the mother, who seems fond of her, is now in- 
fluenced by her husband to put her away because of her 
disease. So it has been a struggle to keep Angeline where she 
belongs, in her mother's home. One's heart naturally goes 
out to these little ones who are unwelcome guests, yet they 
present one of the most difficult problems. 

Charles 

Charles was three and a half years of age when referred 
from the dispensary to the hospital for treatment of a possible 
injury to his hip. His parents were Germans, and the mother 
was loath to leave him for fear he would cry, and as he under- 
stood nothing but German she thought he would not be able 
to make his wants known. Her fears were allayed and she 
consented to let him stay. How little did the social worker 
realize that this was the beginning of desperate struggles with 
these parents to give this child what he must have to prevent 
his being a lifelong cripple. Examination in the hospital 
showed the hip was tuberculous, and the only treatment was 
the application of an extension and weights. Before doing 
this the doctor asked the social worker if she would see the 
parents and explain the treatment, and find if they would con- 
sent to it and to the child's staying several months, as it would 
necessarily take a long time. The worker visited the home, 
and told the parents that the trouble was a disease of the hip 




Fig. 8. — Charles. 



CHARLES 



65 



and not an injury, and if the child was allowed to go without 
treatment the disease would progress and the limb grow 
shorter, resulting in a crippled boy. As the father had received 
an injury more than a year ago which had crippled him, the 
appeal was made that he surely would have everything done 
for his boy to prevent such suffering and dependence. They 
said they were willing to have the doctor go on with the treat- 
ment which he thought was necessary, and they would leave 
Charles in the hospital as long as it was best. This cleared 
the way for the doctors, and they applied the weights for the 
beginning of the treatment. Imagine the consternation of the 
intern when he was called to the ward the next day and found 
the mother there in a state of great excitement. She had 
loosened the stays and released the weights, completely un- 
doing the work which the intern had so carefully finished but a 
short time before. She was demanding Charles' clothes and 
preparing to take him home, for she said it was cruel treatment, 
and no amount of argument could persuade her that it was 
the kindest thing that could be done for him. After signing a 
release she took him home. The next day the case was re- 
ported to the Humane Society, asking if they could help in 
forcibly retaining the child in the hospital. The result was 
that the agent went with the social worker to the home, and 
found the parents indignant because Charles had been hurt; 
they, in their ignorance, could see no farther than the child's 
tears, and those were increased by the solicitude of the mother. 
They were told that they were neglecting the child, and if they 
did not bring him to the hospital and leave him for proper 
treatment a warrant would be issued for their arrest. They 
then consented, and brought him the following day. The 
child remained for some months under the order of the Humane 
Society, but a great deal of trouble was experienced with the 
parents; they were ugly and unreasonable at times. After a 
siege with scarlet fever, contracted on the ward, it was thought 
best to let Charles go home and return to the dispensary for 
observation. His father brought him back just once, and al- 
though visit after visit was made to the home, they flatly re- 
fused to bring him. It was evident the disease was progressing, 
for the child was looking pale and thin, and he could not stand 
s 



66 



"the hospital as a social agent" 



or walk. Finally, after repeated efforts of the social worker, 
the father brought Charles to the dispensary and the doctor 
found that both hips were now involved, and the only thing for 
the child was to place him in the hospital. As the father was 
ugly and demanding at this time, trying to dictate the kind of 
treatment the boy should have if he left him, the only course 
to pursue with success was to get control of the case through 
the intervention of the court. The matter was taken up with 
the Humane Society again to get a court order to hold Charles 
for treatment without any interference from the parents as 
long as the doctors deemed it best. This was accomplished, 
and Charles is receiving every attention that his case demands. 
The court told the father that he and his wife must not inter- 
fere in any way with the hospital, that if they did the work- 
house sentence which the court imposed would be carried out, 
otherwise it would be suspended. Even after this it was 
necessary to exclude them from the hospital as visitors, 
because they came one evening under the influence of liquor 
and threatened to make trouble. 



CHAPTER VII 



HUMAN ECONOMY AND ECONOMY OF 
RESOURCES 

Much that has been said in previous chapters bears more 
or less directly upon the conservation of human energy and 
the economy of resources in the community, so we will en- 
deavor now to gather together the important points and 
clinch them. 

After all, human economy is our object in social work. By 
eliminating the unfit, we strengthen the beings that remain; 
by repairing the injured or crippled member, we literally 
put individuals on their feet and give them to the world for 
useful service ; by effecting a cure in the best possible way and 
the least time, we may not only spare a life, but make it 
yield more abundantly in energy for the world's work; by 
taking care of the mother's problem in the home so as to make 
it possible for her to take necessary treatment in the hospital, 
we economize her strength and vitality for use in her family; 
her children are better physically, mentally and morally for 
her best care, and they will be more to the world. 

The following stories of Josie and Frankie illustrate the 
economic value of social service in putting individuals on 
their feet. 

JOSEE 

Josie was three years old, but owing to a congenital condi- 
tion he had never been able to walk. The visiting nurse 
found him sitting on the floor or in a chair trying to amuse 
himself, and determined that something should be done to 

6 7 



68 



" THE HOSPITAL AS A SOCIAL AGENT " 



better his condition if possible. She brought him to the dis- 
pensary for examination, and the doctor referred him to the 
hospital ward for treatment. Josie's father had died a few 
months before, leaving the mother with three children and 
pregnant. A widow's pension was secured for her and help 
from a relief agency, that she might take care of her children 
herself. But Josie was bound to grow up a helpless, dependent 
child unless something was done to straighten his legs and make 
them strong enough to hold him up and to be of use in walking. 
The mother had a great enough task to keep her family together 
without having a crippled child to support, to say nothing of the 
boy, whose whole life would be marred by this handicap. The 
problem in this case was to direct the medical social service 
toward making a normal child who would be capable of taking 
and holding a normal place in the home and in the community. 
These facts were given to the doctor, who at once became 
interested, and set to work to build up the physical condition 
of the child ready for the operation. Josie was especially 
bright and attractive, becoming a favorite with everyone in the 
hospital, and he was given every opportunity with medicine, 
food, and fresh air to prepare for what was before him. Finally 
the doctor operated on his legs, putting them in casts, as he is 
seen in the picture. In his usual happy disposition, Josie 
spent the weeks in this constrained position waiting for the 
day when he should be free from the fetters whose purpose 
was a mystery to him. The great day came at last when the 
casts were removed, and it was only surpassed by the day 
when he stood for the first time in his life on both feet. He 
soon learned to walk, and the social worker was instructed by 
the doctor to obtain proper shoes that would give the support 
he needed until he gained strength in his feet and ankles. Any- 
one witnessing the mother's joy and gratitude when she took 
Josie home would feel that time, money, and efforts had been 
well spent in putting this boy literally on his feet. Josie now 
has a new father, the family are living in the country, are self- 
sustaining, and in a position to continue so, and the case has 
been closed by the different organizations assisting. The 
derrick has lifted the load, swung it about, dumped it on new 
ground, and reconstruction has been accomplished. 




Fig. 10. — Josie returned to his family. 



FRANKIE 



6 9 



Several important principles in social work are illustrated 
in this case. First and foremost, the individual was trans- 
ferred from the dependent class to the independent; second, 
the family was kept together, and through the close touch of 
different organizations the mother was taught many things 
of value about the care of her children, and the moral support 
she received helped to make her a better home-maker; third, 
the Home for Crippled Children was robbed of one poor 
victim, and the dismal, dark room where Josie spent his days 
lost the child who now runs about wherever he will, playing 
like other children; fourth, the case demonstrated the need 
for hospital social service, and shows its place in the commun- 
ity. There is no question of the economy of individual and 
public resources. 

Frankee 

Five-year-old Frankie was brought to the hospital with 
badly crushed legs, having been run over by an engine while 
" hopping trains," as he himself said. The surgeon found there 
was no hope of saving his limbs, and it was necessary to am- 
putate them at once. He made a good recovery, and in time 
was completely healed and ready to leave the hospital, but 
where was he going and what was he to do, with his whole life 
before him and no means of locomotion? He had been living 
with his uncle and aunt in a mere shack of a place, under the 
worst home conditions that could be imagined — drunkenness, 
dirt, and shiftlessness abounding. His parents were Slavish, 
but nothing is known of them or any other members of his 
family except an older brother, who came to see him later. 
His uncle and aunt soon stopped visiting him at the hospital, 
for they considered him no good to them, and as he was devel- 
oping into a very lovable, bright boy their home was not the 
place for him. The first thing to investigate was the arti- 
ficial limb proposition, and see if he could be fitted at so early 
an age. This was found entirely possible, and a subscription 
was started to raise the necessary funds. Among nurses, 
officers, and doctors at the hospital, friends, railroad officials, 



7° 



"the hospital as a social agent" 



and hospital board the sum of $200 was raised and the limbs 
were ordered. At Christmas time Frankie received the gift 
of a little wagon, with which he pushed himself all about the 
hospital. He was so agile he climbed about like a monkey, 
and no task was too hard to deter him from attempting. These 
qualities showed what there was in the boy to make him worth 
while. The day came when Frankie was to go to a nearby 
city, where his limbs were being made, to have them tried on, 
and the journey was a wonderful experience for him. As one 
night must be spent in the city, arrangements were made with a 
sister hospital to care for him. When he returned the days 
seemed long awaiting the arrival of the "new legs," as he 
called them, but at last they came, and there never was a 
prouder, happier boy than he when he stood on them and 
realized that he was to be like other boys again, or nearly so. 
As soon as he could get about without help he was transferred 
to the County Children's Home, and so became a county 
ward. Frankie has made a place for himself in this home, 
is much beloved, goes to school with other children, and is 
waiting for someone to love him hard enough to adopt him. 

So we might go on, showing specific examples of medico- 
social work directed toward human economy. Every indi- 
vidual member of society is needed for some part of the world's 
work, and just so far as he is unfit for his job the world in 
some degree suffers. Our task, then, is to eliminate the evil 
and dangerous influences, to effectively repair waste and 
damage, and to create wholesome surroundings for human 
beings. It is the whole man, physical, mental, and moral, 
that must have consideration, as the normal or abnormal 
condition of one part affects the others. Jack London says, 
"Men cannot be worked worse than a horse is worked, and 
be housed and fed as a pig is housed and fed, and at the same 
time have clean and wholesome ideals and aspirations." 
This is only too true, and the trend of the present age is to 
bring about the adjustment of affairs and conditions so that 



Fig. 11. — Frankie, after three years in the home. 



HUMAN ECONOMY 



71 



human energy will be conserved and used to the best advan- 
tage. 

There are many individuals who form a part of society 
who do not appreciate values in any way; their life is more or 
less of an existence without thought of economy or any day 
beyond today. Neither do they realize their relation to other 
members of society, so live independently and freely. Those 
who do understand values and relations have a deep responsi- 
bility for the education of the rest, and for the forcible ad- 
justment that is necessary for the protection of all classes. 

In this matter of human economy the hospital is deeply 
concerned, for it is dealing with the physical energy in man. 
As it was stated in a previous chapter, the patient who is 
forced by reason of circumstances to seek free or part free 
treatment is entitled to the best service that can be provided, 
and the hospital organization must be equal to this demand. 
The medical staff is a most important part of the organization, 
and the guards at the entrance should be so watchful that it 
is impossible for any unscrupulous or self-centered doctor 
to gain admission. Viewing the hospital from the side of its 
responsibility as a social agent in the community, nothing 
is more deleterious to its life and growth than to have on its 
medical staff physicians and surgeons who are careless and 
indifferent in the performance of their duties, or who make 
free patients the victims of exploitation. Some doctors of 
this type in their private practice obtain money from ignorant, 
unsuspecting people who receive no benefit, and when their 
money is gone they are obliged to seek free treatment either 
in the dispensary or hospital. Fortunate are they if the 
delay has not jeopardized their chance for recovery. 

Knowing these facts, then, are not social workers who 
admit patients for dispensary service justified in accepting 
a person for treatment who is ignorant enough to become a 



7 2 



" THE HOSPITAL AS A SOCIAL AGENT " 



prey to such doctors? And in sparing such a victim are we 
not relieving the public from a possible danger or burden? 
We would refer to Chapter II (p. 21), where the duties of 
the admitting officer are spoken of. 

There is another class of persons we believe to be eligible 
to dispensary service. It is those whose financial resources 
should be conserved either for the support of the family or 
for the waning human forces which will be soon exhausted. 
Again, there is a class of patients whose condition is such that 
if the complete facilities offered in the hospital and dispen- 
sary are made use of there is every chance for their full re- 
covery, whereas the inadequate office equipment of the pri- 
vate physician to whom they might afford to go lessens their 
chance. Do not principles of human economy and economy 
of resources apply here? We would not for one moment 
submit to any abuse of the dispensary or hospital if we were 
aware of it, nor would we rob the private physician of any 
practice that rightly belongs to him, but it does seem that 
human rights may claim as much as unscrupulous, selfish 
doctors. 

The economic resources of the communtity should be a 
matter of much concern. All that has been said about human 
economy applies to this part of the subject, for adequate 
treatment saves time, and time in the hospital costs money. 
Every man of good earning capacity helps to circulate money, 
and every one who is equal to his task is worth money to his 
employer. Compare the ablebodied, efficient workman with 
the shiftless, broken, incapable class that is shipped about 
the country for cheap labor purposes and employed by big 
corporations in construction work. They are a burden to 
every community they enter, either in the police courts, 
almshouses, hospitals, or relief agencies, and they contribute 
nothing to the business, as they have no money to spend. 



JOHN R. 



73 



The case of "John R." shows how one of these undesirable 
floaters was returned to his own people and the community 
was spared the burden of his support. 

John R. 

John R., age thirty-one, U. S., address European Rooming 
House, laborer, not working now; physical defects, right arm 
amputated, apparently feebleminded. 

The patient applied at the Out-patient Department for 
treatment of an axillary abscess. This was taken care of, and 
he was discharged as cured in a week. Although the medical 
service rendered was very small because the need was slight, a 
complicated problem was opened up which called for intensive 
social work. The record reads as follows: 

Sept. 3/15. Patient was very dirty when he came to the 
dispensary for treatment, calling forth a protest from the 
doctor who attended him. As he was staying at a cheap 
lodging house, without proper facilities for a bath, he was 
given a card to a settlement house in the neighborhood for a 
bath. Clean clothing was provided also. 

Sept. 5/15. Patient returned to the Out-patient Depart- 
ment for surgical dressing. He looked much improved and 
expressed gratitude for the favor. Something in the man gave 
the impression that there must be some refinement back of 
his feebleminded, unkempt condition, and inquiry was made 
about his home. Handicapped as he is, it is going to be dif- 
ficult for him to support himself, and he will be likely to fall a 
prey to unscrupulous persons who will take advantage of his 
feeble mind. He gave a very accurate address of an aunt in 
the East, and a letter was written to her at once, stating his 
circumstances, and asking if there were some relatives that 
could come and take him where he might have the protection 
he needed. 

Sept. 12/15. Reply was received from the aunt, saying 
that John had two sisters and a brother whom she was writing 
to the same day, and she was sure they would send money for 
his return home. They had been trying to locate the boy for 
some time, but had failed, and were indeed glad to know of his 



74 



" THE HOSPITAL AS A SOCIAL AGENT " 



whereabouts. Call made on this date upon a Mr. V., who 
keeps a lodging-house across the street from the one where 
John is staying. As we knew that Mr. V. would co-operate 
with us in the case, we asked him to get John over to his place 
that he might help to keep track of John, and whatever ex- 
pense was incurred for his board would be met when the family- 
were again heard from. 

Sept. 13/15. Mr. V. telephoned that John would not 
change his boarding place, as he preferred to stay where he 
was. He says certain lawyers have his case to try and get a 
settlement from the railroad for the loss of his arm. They are 
paying him $5.00 a week while he is waiting, and say they have 
sued for $50,000. John expects to get one-half when the 
claim is settled, so he is much elated at the prospect. 

Sept. 29/15. Letter received from the sister in the West, 
enclosing one for John and $30 to be used for his expenses 
home. John visited the hospital, and his letter was given to 
him, but the money was left with the social worker until he is 
ready to go. 

Oct. 5/15. John's uncle from the East came to see what 
was best to do with him, as the family did not wish to have him 
roaming about the country. The uncle seems to be a kind- 
hearted, good, intelligent man, and says that John has lived at 
his house much of the time since his mother died. He has a 
roving disposition and will not stay at home, although they 
have done everything they could to hold him. For months at 
a time they would not know anything of him, and he has not 
been home now for about three years. 

Oct. 7/15. The uncle returned to his home. In the two 
days of his stay he called on the claim agent of the railroad 
and also the lawyers. The claim agent said John was a 
trespasser, and so they were in no way responsible for his 
treatment, but they had paid the hospital bill, gotten him a 
new suit of clothes, and given him $10 for his ticket home. 
Nothing else could be expected of them. The lawyers said 
they were hopeful of getting a settlement, that they had many 
such cases on their list, and were very successful with them. 
They wanted John to stay in town until the case came up in 
court, and they were willing to pay his expenses in the mean- 



JOHN R. 



75 



time. While in the lawyers' office John came in, and the uncle 
was much shocked to see how changed he was. His mental 
state was much weaker than when he last saw him. John was 
a patient in the Texas State Hospital a few years ago, and he 
has been wandering about since he was released from there. 
The uncle talked with him in a confidential way, and found 
that he had delusions and hallucinations, and he felt that it 
would be difficult to care for him at home. If possible to 
accomplish it State Hospital care was best for him. Not 
wishing to take the responsibility himself, he telegraphed to 
his sister, asking if she would advise placing him in a hospital 
for the insane. She replied she wished the uncle to use his 
judgment in the matter. He called upon the Probate Judge, 
to ask if he would commit John to a hospital in this state, 
but he said John's legal residence was not here and he should 
go to his home to be committed. As the laws of the other 
state would not permit a relative to bring a patient back for 
the purpose of committing him, the judge advised leaving him 
until the lawyers had finished with his case. It might work 
against his chances for a settlement to declare him insane. 
With these facts in consideration, the uncle thought best to 
go back and leave John's case in the hands of the social worker 
to complete as matters developed. 

Nov. 12/15. John reported that the lawyers had not suc- 
ceeded in getting his case brought into court, and as it might 
be some time before they would accomplish anything they 
thought he had better go to his home, and they would send for 
him if it did come up. John is willing to go and wants to start 
at once. 

Nov. 13/15. Bought railroad ticket and wrote out direc- 
tions for changes of cars, etc., and arranged with Mr. V. to 
put John on the train, giving him a small amount of change for 
meals. Telegraphed the uncle when he would arrive home, 
and sent balance of sister's money by mail. 

Nov. 17/ 15. Received letter, saying that John had arrived 
home, and that they would keep him there until they could 
decide what was best to do with him. 

A year later learned that John had been at his uncle's 
or his brother's ever since he left here, and he was getting along 



7 6 



"the hospital as a social agent" 



pretty well, but they could see he was failing mentally. Before 
leaving for home he started to drinking quite heavily and took 
no care of himself, seeming to desire nothing but a mere 
existence, so he was a pitiful specimen when he was put on the 
train. The uncle, having seen him, and knowing how unkempt 
he was, desired to save the family the shock of his appearance, 
so he met him at the train and had him cleaned up before 
taking him home. 

There are some undesirable persons that can never be 
made to take their place in the world, but there are others 
that may be helped to become self-sustaining and relieve 
the community of the burden of their support. If municipal 
and county authorities could appreciate these economic 
values, they would then become helpful social agents, and 
money spent for useless individuals might be saved for those 
who are beyond working ability or who are accidentally help- 
less. These officials would profit by securing the service of a 
competent, experienced social worker, who would help to 
give them a social vision which they are incapable of because 
of the blinding effects of politics or greed of gain. How use- 
less to support a young fellow indefinitely in the county home, 
who is unfortunately crippled by a double amputation, in- 
stead of spending $200 to secure artificial limbs and fit him 
for some place in the world. With a social worker to adjust 
him to his work and to his place, he may be transformed from a 
useless dependent to a self-respecting citizen, capable of his 
own support. From the standpoint of the saving of money 
it is a simple problem in arithmetic, counting the man's board 
in the home at $15 a month, in one year he would cost the 
county $180, almost as much as the artificial limbs. Multi- 
plying this amount by forty years, which would complete 
the average life, one can readily appreciate the fact that public 
funds are expended to no purpose except to keep the man alive. 



ECONOMY OF RESOURCES 



77 



The loss of service to the world, and the injustice to the young 
man by depriving him of his ambition and opportunity, is 
also a serious consideration. 

Social workers are well aware of the disadvantages arising 
from the lack of appreciation of the real social needs of the 
indigent poor by public officials in town and county. The 
proper solution of a social problem may require the assistance 
of one of these agencies, but there is often great difficulty in 
getting them to understand the value of real adequate treat- 
ment, and, as there are no other means at hand, workers are 
at a loss to know what to do. These officials are prone to 
employ incompetent persons for positions where experts 
alone should be placed. While larger salaries must be paid 
to secure such competent help, money would be saved by 
shortening the period in which the individual might be de- 
pendent. The most efficient service is the most economic 
all around. 

True, the indigent class of people are very unsatisfactory 
to deal with, but the community demands proper handling 
for its own protection, and do not these people with their social 
problems properly belong to public agencies? Then why 
should not the tax-payers insist upon the most economic, 
practical, efficient expenditure of the public funds for the care 
of its indigent, dependent members, both for the sake of the 
individuals themselves and for all who make up the community? 

This question of human economy and economy of re- 
sources then should enter into the solution of all our social 
problems. Any slipshod way, or the one which follows the 
lines of least resistance, is an injustice to all concerned; in- 
deed, it is almost a crime against humanity. No case should 
be taken care of without the ultimate good in mind, and in 
these days of experience and research there is no excuse for 
any social work which is not as scientific as medical work. 



78 



"the hospital as a social agent" 



The wonderfully scientific work which has been done in 
France in the treatment of wounded soldiers illustrates in a 
remarkable degree the principles of economy. The work is 
medical, but it is also social service. The whole plan of organ- 
ization is based upon the economy of the lives of the soldiers, 
of their vitality, and the economy of time and money. There 
must needs be as many men saved and returned to their 
places in the army as possible, and medical experts have stud- 
ied to find a method of treatment which would conserve 
vitality by hastening repair. Prophylactic measures are used 
as soon as men are brought wounded from the battlefield 
without waiting for the hospital to be reached, and many 
lives have been saved through this one precaution. Again, 
those who are maimed beyond complete repair, receive the 
most skilful attention to produce the best possible results 
that utter helplessness may not be their lot the rest of their 
lives. Here is a social and a medical service to the whole 
world as well as to individuals, and it should be a lesson in 
economics to all social workers, but especially to those engaged 
in hospital work. 



CHAPTER VIII 



THE PLACE OF THE HOSPITAL IN PUBLIC 
HEALTH WORK 

The latent possibilities of hospital social service lie in the 
important aid which may be given to public health work. 
Both the immediate community and the state have or should 
have comprehensive programs for public health work, and 
the hospital should be included among the co-operating 
agencies. 

Public health must be promoted by the efforts and co- 
operation of every member of the community. If one man 
suffering from tuberculosis spits on the sidewalk he endangers 
every other person in the community, but if every person re- 
frains from spitting, no one is put in danger from this source. 
The question resolves itself then into a matter of educating the 
public to avoid the sources of danger. That part of the public 
which does not wilfully recognize danger, must be forced to 
observe certain laws for the protection of all. Thus it has 
become necessary to make laws prohibiting spitting. The 
people of the United States have sometimes misconstrued 
the idea of freedom to mean, that if I wish to throw my 
garbage over the fence I am permitted to do it, so long as it 
does not annoy me nor my family and if it saves me trouble 
and expense. I am the one, as well as my neighbor who is 
ignorant of the danger there is in my open garbage and his 
uncovered manure pile, for whom public health laws are made 
and enforced. 

79 



80 " THE HOSPITAL AS A SOCIAL AGENT " 

Not only must we educate people, either willingly or for- 
cibly, but we must provide adequate means and facilities 
for the care of communicable diseases or those which are the 
result of unsanitary surroundings, and see that health offi- 
cials enforce the laws which eliminate and regulate all possible 
sources of danger to the health of the community. Adequate 
means and facilities for the care of disease include sufficient 
hospital beds, and proper equipment to take care of tuber- 
culous patients and those suffering from all contagious and 
specific diseases. Unless a community can properly take care 
of those who are sick from these ailments, it cannot expect 
to stop the progress of disease nor to effectively educate the 
public to its danger and to the necessity of medical care. 

Another feature is important, that of careful examination 
and diagnosis, and the detection of disease in its beginning 
stage. This is where the hospital and dispensary can aid so 
efficiently in Public Health Work, for its equipment is com- 
plete and its medical service equal to the demand. Differ- 
entiation in diagnosis can be more easily determined, and the 
social worker is able to direct her efforts in the right direction. 
This is especially true with venereal diseases and tubercu- 
losis. Those needing special hospital care are placed where 
they can be treated; those who may be taken care of in the 
homes and treated by dispensary physicians can be followed 
up with evident benefit; those who are beyond help may 
have medical and social treatment directed toward the com- 
fort of the patient or his removal to a place of safety for 
others of his household. 

David, a Tuberculous Patient 

David, age seventeen; single; born U. S. 
Feb. 7/14. Patient referred from the Out-patient Depart- 
ment to the hospital, quite sick with pleurisy. Investigation 




Fig. 12. — A breeding place for physical and moral disease. 




Fig. 13. — The little girl on the extreme left is already showing the truth of 
Jack London's saying. 



DAVID, A TUBERCULOUS PATIENT 8l 

shows that he and his sister, nineteen years old, live with and 
support their grandmother, who has raised them from child- 
hood. The sister is a typewriter, working in a company 
office, earning $35 a month. The patient has been making 
$10 a week for a short time, driving for a grocery store. The 
family pays $15 for three rooms in a flat, without heat or light. 
The boy has been sick three weeks, consulting a doctor but 
once before coming to the Out-patient Department. Examina- 
tion in the dispensary showed pleurisy with effusion and prob- 
ably pulmonary tuberculosis. Called David's sister by tele- 
phone to tell her that he was admitted to the hospital, so she 
might explain to the grandmother. She came to the hospital 
to see the social worker, who told her the nature of David's 
trouble, and what might be necessary for him when he was 
ready to leave the hospital. 

Feb. 9/14. Visited the home and saw the grandmother. 
She fears that they must move into cheaper rooms if David is 
ill and unable to contribute to the support of the family, but she 
will do the best that she can. The family being Catholic, the 
case was reported to the St. Vincent de Paul Society for as- 
sistance if it became necessary. 

Feb. 21/14. Visitor from the St. Vincent de Paul Society 
called to say that they had no funds to pay for David at a 
sanatorium, if it seemed best to send him there, but they would 
be glad to give the family relief if that was necessary. 

Feb. 25/14. The attending physician on the ward reports 
the condition of the patient so favorable that he thinks it will 
not be necessary for him to go to a sanatorium. As he has an 
uncle on a ranch in Montana, he thinks he may be able to 
arrange to go out there to recuperate. This plan is approved 
by the doctor, when the weather is favorable and the patient's 
strength will permit. 

Feb. 26/14. Saw sister and talked over the plan with her, 
and asked if David could be cared for properly at home until he 
was able to go away. She said she thought he could, and that 
she would write at once to the uncle, so as to start preparations 
for the trip. 

March 1/14. Visited the home and talked over necessary 
arrangements for the home care. Find that he can have the 

6 



82 



" THE HOSPITAL AS A SOCIAL AGENT " 



exclusive use of the front room, where fresh air can be obtained 
day and night. Gave instructions as to the importance of 
fresh air and proper food and necessary precautions to take. 

March 14/14. Patient was discharged from the hospital 
and went home. Ordered 1 quart of milk and \ dozen eggs 
sent every day, and had same charged to the Antituberculosis 
Society, by their order. He is to report to the dispensary 
twice a week for observation. 

April 2/ 14. Visited patient in his home, and found him in 
splendid condition; he has gained 10 pounds since leaving the 
hospital. He has heard from his uncle in Montana, who sent 
him the money for railroad fare, and he will let him know as 
soon as the weather is warm enough out there for him. 

April 11/14. Patient returned to the Out-patient Depart- 
ment with a return of pleurisy, and the doctor referred him to 
the hospital wards again. His condition at this time seems 
to point more decidedly to a tubercular involvement, and the 
doctor advises a short stay at the sanatorium before starting to 
Montana. It was then necessary to find some means to pay 
the $5 a week fee at the sanatorium. This was obtained 
($30) from the "Fellowship Fund" in one of the Protestant 
churches. 

May 16/14. Patient transferred to the sanatorium by his 
sister, she furnishing the money for the trip. 

July 11/14. Patient returned from the sanatorium, very 
much improved, having gained 20 pounds in weight, and looking 
rugged and well. He made good progress during his stay, and 
the doctor's judgment is that his is an arrested case, which will 
do well in right surroundings. 

July 18/14. Patient started for Montana, very happy and 
grateful for all that had been done for him. Before leaving a 
visit was made to the pastor's study at the church which had 
furnished the money for sanatorium fees, in order to thank the 
minister in person for the aid which had been given. 

Nov. 10/14. The following letter was received by the 
social worker which will speak for itself: 

"Dear Miss C: I'm sending you a few lines to tell you 
how I am. I feel fine out here, the air is fine, and I can 
eat like a horse. I hope you feel the same. Please excuse 



THE HOSPITAL IN PUBLIC HEALTH WORK 83 

me for not writing, we've been branding calves and horses 
and making hay for winter. I got awfully strong out here, 
I have lots of fun riding horses and hunting wolves and 
wild ducks and chickens. I have 320 acres of land 
right near my uncle's place. Be sure and write and tell me 
how yoti are and everything at home. I lost the minister's 
card, so do not know his address, you can send it to me, 
I like to write him a letter. Well, goodby, from your 
friend, 

David." 

Recognition should be granted the hospital as a co-oper- 
ating agent in the program for public health work, and in 
order to command this service the hospital organization, 
medical and social, must prove its efficiency. With this es- 
tablished, why should not the dispensary be sought by city 
and county authorities for its examining agent, and a certain 
amount of money be appropriated regularly for this service? 
Would this not be better, from the standpoint of economy, 
than to trust this important work to incompetent means 
at their disposal? And would not more efficient work be 
accomplished for the welfare of public health ? 

Another valuable aid is shown, by careful examination 
and accurate diagnosis that is possible in the dispensary, in 
the detection of such contagious diseases as diphtheria, 
scarlet fever, and small-pox. Take, for example, the young 
man who arrives in the city without money or friends, and, 
feeling sick, seeks the dispensary for the doctor's advice. 
General symptoms, throat condition, laboratory examination, 
present unmistakable evidence of diphtheria. He cannot be 
taken into the hospital that has no contagious ward, nor is 
it just to him or to others to send him out on the streets, 
knowing he has no home to go to, nor any means of obtain- 
ing suitable care. A message to the local board of health, 
whether or not they have a contagious hospital, should be 



8 4 



"the hospital as a social agent" 



all that is necessary to obtain immediate attention in this 
case, and it is the only one that should satisfy the public 
mind for the protection of every member of the community. 

Aside from the accurate diagnosis of cases and actual 
care of patients, the dispensary is an important aid in the 
program of public health work through its value as an edu- 
cational center. There is no focal point more crucial than 
this for education in the laws and principles of hygiene and 
good health. Especially is this true with tuberculosis and ve- 
nereal diseases and the disorders of infants due to ignorance 
of parents. The social worker makes special effort to investi- 
gate the home surroundings, discovers the unsanitary condi- 
tions, and sees the unhygienic ideas manifested in the symp- 
toms of the patient and recognizes the danger to others. 
With this intimate touch in the home, and the vantage point 
in the dispensary, where numbers may be gathered together 
in classes, the benefits of teaching are enhanced many fold. 
Such splendid work may be done by grouping the mothers 
and babies, and, by means of demonstration and instruction, 
to show the mothers the proper methods in the care of their 
babies and the reasons why. A spirit of interest may thus 
be engendered to follow instructions and watch the results, 
not only each one in her own baby, but in every other child 
that is brought to the class. This is a part of the program for 
infant welfare which should form one of the co-operating 
forces in this line of public health work. 

The importance of education in the clinics for venereal 
diseases cannot be overestimated, as we are dealing with the 
direct results of the cause of the trouble. We are able to 
reach the very source of the spread of the disease, bringing 
special emphasis upon the dangers to present and future 
generations, besides the danger from direct contact. 

Illustrative of this is the case of a young girl seventeen 



Fig. 14. 




THE HOSPITAL IN PUBLIC HEALTH WORK 



85 



years old who visited the dispensary for treatment of a throat 
trouble. The specialist recognized an active case of syphilitic 
infection, which called for prompt treatment to prevent further 
progress of the disease and imminent danger to others. The 
girl was a nurse maid in a family where there were several 
small children, one a baby which was her special care, and 
whom she was in the habit of kissing and fondling. Here 
was a desperately critical situation, where not a moment 
should be lost in starting immediate medical and social work, 
and it is needless to say the girl had hardly left the dispensary 
before the note of warning to the mother of the children in 
the home was sounded over the telephone. 

In the prevention of the spread of eye diseases and the 
conservation of sight there is an important co-operative 
work. Wonderful results may be obtained through home 
investigation and instruction in prophylaxis and hygiene, 
and in bringing about the persistent return of the patient for 
treatment until he has been cured. Also in co-operation 
with school nurses and teachers, securing necessary glasses 
for pupils that the sight may be saved, a public service is 
rendered. 

So we might go on elaborating along different lines, but 
enough has been said to expose the underlying principles 
which the social worker in any small hospital community may 
put into practice in the development of her department. 
We feel sure that all will agree that the development of hos- 
pital social service must be along the lines of public health 
work, which is broadening out to meet the demands of the 
community for protection against all sources of danger to 
the health of its individuals. 



CONCLUSION 



In the foregoing chapters an endeavor has been made 
to demonstrate the established work of the hospital social 
service department and to show its future possibilities. The 
hospital has always held a most important place in the com- 
munity, indispensable in its service to suffering humanity, 
and winning its way into the hearts of the people through 
increasing confidence in its work. Social service has devel- 
oped the hospital's value and increased its usefulness as a 
social agent. It has placed the hospital in the forefront as an 
important asset in the welfare of the community and of the 
state. 

Much stress has been laid upon the service to the indi- 
vidual, to the community, and to society, and the reiteration 
may seem superfluous and tiresome to some degree, but its 
great importance links it so closely to effective, adequate 
service that it will bear frequent repetition. Individuals 
make up the community, communities form society, so what- 
ever good or evil is in one affects the others, and whatever 
influences are brought to bear upon one helps to make the 
others. An individual burden becomes a community burden 
and individual economy is a community benefit. These are 
things that science teaches us. Social work has become scien- 
tific in as great a degree as medical work, for it deals with the 
whole man — his physical condition, his aspirations, his pas- 
sions, his work, his place in the world. Sickness is often the 
adversity which changes the life and purpose of the man; 
it sometimes forces him into entirely different channels, 

86 



CONCLUSION 



87 



where new adjustments are necessary. "The study of char- 
acter under adversity is the essence and center of social 
work." Opportunities for great service, therefore, come to 
hospital workers and make the obligations to the community 
most profound. 

Social service is not new in its conception or operation. 
It is but the scientific development of what was formerly 
called "charity work." Yet there existed in the minds of the 
charity workers years ago the essential principles of most 
effective social service. Because of the voluntary element 
organization was incomplete, and facilities which are at hand 
today were not available for the proper conduct of case work 
then. Illustrious examples of volunteer workers remain in 
the memory of beneficiaries never to be erased, and these 
workers are the ones who have laid the foundations for the 
present scientific system. While hospital social service is 
one of the new developments, it is really only the application 
of old, tried principles to the needs of hospital work. 

The inspiration for this book came from long association 
with one who was a leader in many benevolent enterprises 
thirty or forty years ago. She worked out social problems 
with a wonderful insight into the causes of social maladjust- 
ment, and broad ideas of reconstruction. Yet her days of 
active duty were over before the hospital child was scarcely 
out of its swaddling clothes. It was her love of humanity 
and her sympathy for people to whom adversity came, and 
her service which was actuated by a Christ-like spirit, that 
produced the far-reaching results whose influence is still 
felt in the community where she lived and worked. 

We can scarcely conceive of a successful social worker 
in the hospital whose life is not dominated by the love and 
spirit of Christ. The hospital has always been a sacred in- 
stitution. The first one was established by the Good Samar- 



88 



" THE HOSPITAL AS A SOCIAL AGENT " 



itan when he found the wounded man, placed him on his 
own beast, and took him to an inn. We are told he took care 
of him, and in the morning when he departed he endowed 
the first hospital ward for this patient. Thus, what we now 
call social service was made complete in this case, and Jesus 
said to the lawyer whose question called forth the parable, 
"Go, and do thou likewise." 



APPENDIX 



Facsimiles of the different forms of blanks used in the 
Social Service and Out-patient Departments of the Youngs- 
town Hospital are here appended for the purpose of suggest- 
ing to those who are seeking help a plan of record keeping 
which has been worked out and found to be complete and 
yet simple. 

The matter of records is most important. Social histories 
which exist in the memories of workers are utterly valueless, 
yet it is many times a question with busy workers whether 
to sacrifice the social work or the records. History taking 
and record keeping then resolves itself into a matter of pro- 
viding blanks that are simple but comprehensive, and of 
developing an indexing and filing system so easily understood 
that the record's are available to any hospital official seeking 
information. 

Reference blanks are of the greatest value, as they work 
automatically in carrying out the system for the proper care 
of the patient, and help to complete the records. This is 
shown in the set of cards and blanks which take the patient, 
Annie Yorchek, from her admission to the out-patient depart- 
ment, through the hospital, back to the out-patient depart- 
ment again. 

Record keeping should be so planned that a complete 
history of a case may be made with the greatest conserva- 
tion of time and energy on the part of the worker. The plan 
should also be perfect enough to furnish accurate information 
of the medical and social status of the patient, and the full 

8 9 



go 



" THE HOSPITAL AS A SOCIAL AGENT " 



record should be filed in one envelope or holder with all cor- 
respondence or papers which pertain to the case. 

Some of the blanks in the facsimiles have been filled out 
to demonstrate their use, while others are self-explanatory. 



Hospital Wo. y ^ Wart 0 , r Sctvto Q*^^ f 



Rellltloti 



sgg. 




Fig. 16. — Hospital Social Service case, short history form. This card 
combines the case history and index card, and shortens the process of history 
taking and filing. The name, address, hospital number, ward, service, and 
date of admission is obtained from the hospital admission blank, and the 
card is taken to the bedside of the patient for the record of the social history. 
If no special work is necessary for the patient, all that is required to complete 
the record when he is discharged is the diagnosis, discharge date, and a 
statement of the disposition of the case. This card is then filed with the 
other index cards, and its face shows it to be a short history case. 



APPENDIX 91 




Fig. 17. — Reverse side of history case card. 



92 "the hospital as a social agent" 

The Youngstown Hospital Association 

Social Service Department 
Hospital No. Name S. S. Dept. No. 

3UA4.fi ratm, mmv, saa — 

Address Service Ward 

u .i c.nt»r at. Qhal^ 0 

Admitted Discharged Age Nationality Years in U. S. City 

i/M/is a/1 a/i k. 84 Hung, 2 2 

Relieion Pastor 



Hlin gfl T .1»n Bafnrincd R»W . Pnf l lf f> M S? W. ^. 

Diagnosis 

Pregnancy , — — . ■ 

History, etc. 

■Tnn . 3 1 .1 01 5. P a t i ent , pre s e n t ed her s e l f a t th e front d oo r asking ad- — 
mlBslon for her confinement. The caae was referred to the S.S.Dept. 
to obtain social history before admitting her. Her story was that 
her husband was not good to her, that ha swore and abused her, and 
she wished to escape these troubles when she was sick. There was no 
one to care for her at her home, and she felt she would soon be sick. 
Her husband works at the Steel Hills, and they llye In a part of her 
husband's father's house. As she was a member of Rev.Panko's Church 
called him by 'phone to ask if he Jmew of the woman and her troubles. 
He came to the Hospital and saw her> listened to her story, and e&ld 
It was no doubt true what she said about his abuse, and that her sad 
face told the story. These fasts were corroborated by a patient in 
the ward and her husband, as they knew her. The doctor's examina- 
tion showed a probable wait of two weeks longer, but as the weather 
was most severe outside, and her husband had driven her from home the 
night before, she was admitted, after consulting the superintendent. 
Feb. 1.1915. Patient was confined early thlB morning. 

Feb. 13. 191 5. Patient 'b husband took her home. The minister had talk- 
ed with him and prepared the way for the home-coming. 

Fig. 18. — Hospital Social Service case history form. This record 

is used in cases where more intensive work is done, or the nature of the case 

needs a fuller record of the facts. 



BALOG, ROSIE #538 
11 A flAnt.AT* «♦ 



Fig. 19. — Index card for Hospital Social Service case. 



^The Youngstown Hospital Association 

PU CHARITIES Out-patient Department 
HUMANE SOO Social History and Record 
V.N. A. 


Caa« No. 

H 0 7 J 

Clan 
Date 

MAX 28 1916 


Paaent'i Surname Firtt Nam* 
Q £**\**</isS j ft iri ^rf. ^ / , 


ftL F . M S-\8, 






Nationality 

9-6. Or r^...- 






Length OfTune to V 
City ^ State ^ U. S. 


Nik ol Father ■ UrifarJ 


WuW Mother 


Rent 

, 


SupporCrf FamJr OcoipsbM 


Employer / 


Porsible 
-Wage 

j -7 


Actual 
. Wage 

? 7 


Boardcn «f Other Income 


CTuidrra Working 




Employer 






Other DepertdeDta 












FlrrneaJ Defect* or Other B— jfcg Citcrtuarlaacea 






/,,-«- 






Family Phy»Ki*n ' 

Dr. 












JUdro. 


No. Children Hoax 

-r 


No. H 


imed Total Children 


Total 


Total 



co.s. 



Fig. 20. — Out-patient Department Social History case form. The so- 
cial history of each applicant for medical treatment is taken on this blank, 
and the eligibility of the patient for admission is based upon this history. 
Any necessary investigation of the case is subsequently made, and if inten- 
sive social work is done, a record is written on the reverse side of the blank. 



THE YOUNGSTOWN HOSPITAL ASSOCIATION 
O. P. D. 


Surname *j _ 


First Name m 

t ~a mm i * S 


Number 

V/7 V 9 




Ate 

is 








Nationality 





Fig. 21. — Out-patient Department index card. This is pink in color, to 
distinguish it from the Hospital case form, which is white. 

93 



94 



" THE HOSPITAL AS A SOCIAL AGENT " 



CLASS 



No. 



OUT-PATIENT DEPARTMENT 



YOUNGSTOWN HOSPITAL 



THREATMENT FREE, TO THE WORTHY POOR 



NAME 




OPEa/2:30 TO 3:30 DAILY. EXCEPT SUNDAYS AND HOLIDAYS 



Fig. 22. — Patient's admission card. This is linen and white in color. 



Bring this card each day. If you lose or fail to bring this card 
you will be charged 5c for another. 

&ringen <Sic fctefe Stavtt tcflli<fc mtt. %aUt @tc fcte« 
fefte t)crlicrcn ofccr nldjt mitfcrittgett. mu{Ten<§ie 5 ©cttiS 
fur cine anfecrc gabtcn. 

Portate qui questa cartolina ognl giorno. In caso non lo fate 
o la cartolina e persa dovrete pagare 5c. 

tny^iyD *irp« Sbs pa jyiy> map yty^n yi b»o twjy-b 
.ttfgyya .d5 m»M dtid jyjjyna n DDyanye *iyi$ map yryn 



NOTICE 



Fig. 23. — Reverse side of admission card. 



APPENDIX 



95 



39-37718 

The Youngstown Hospital Association 

Out Patient Department, Oak Hill Avenue 



Hours 10:00 to 11:00 a.m. daily except Sundays and Holidays 



Address ^ *3 6 1 y ]7ZZ^O^*£*^ 

Referred in- 



Clinic List Other Side 



Fig. 24. — Reference card for outside agencies. 



CLINICS 

General Medical, Every Week Day. 

General Surgical, Every Week Day. 

Genito-urinarv, Every Week Day. 
Eye and Ear, Monday, Wednesday and Friday. 

Nose and Throat, Monday, Wednesday and Friday. 
Obstetrical, Friday Only 

Orthopedic, Tuesday and Saturday 
Dental, Every Week Day. 



Fig. 25. — Reverse side of reference card. 



9 6 



" THE HOSPITAL AS A SOCIAL AGENT " 



PATIENT'S CHECK 

Take this to Druggist to be stamped be- 
fore leaving. 

Youngstown Hospital Association 
Out-Patient Department 

Treatment Free to the Poor 
Medicines and Supplies at Nominal Prices 



Amount 


Supplies Furnished 


Price 




Prescriptions. 






Dressings.- 






Silver Irrigations 






Mercury Injection 




























































No. Supplies Fur. 

Total 









M. D. 

Supplies furnished must be indicated above and 
signed by physician before patient will be passed out 



Date 



PASS CHECK 

Amount Paid 




Fig. 27. — These round tickets, kept on 
a spindle at the desk, are given the patient 
to indicate his turn for treatment, and to 
avoid confusion in getting him into the 
t lg. lb.— Patient s check which is given right room. Different colors indicate dit- 
to him when he is admitted each day. ferent rooms. 



APPENDIX 97 



Form M-8M80 



The youngstown hospital association 

O. P. o. 



AN WILL »LCA«K SIGN E*Cm NOTATION ON Trll» RECORD) 



..MY .28 1916 _ ,.. 




r ~$i£c*^ > _ _ 



II 1916 /Tf2/f? /f 





Fig. 28. — Medical history card. The date is stamped at the desk on 
the day of each visit before the card is placed in the clinic room, thus insur- 
ing correct dating. 



7 



THE YOUNGSTOWN HOSPITAL ASSOCIATION 



O. P. D. 



Date 




Executive Director :— 

In my opinion this patient should be admitted to the hospital 
for treatment— fm operatio n. 




pig 29— Reference slip used when a patient is referred for admission to the 
hospital wards. This is pink in color. 



I would recommend that this patient be admitted to the 
Hospital. Investigation would show that charge should be made to 



tfal Service Director 




Patient admitted under No. 



Supt 



Fig. 30. — Reverse side of reference slip. This accompanies the patient 
to the hospital office, and is returned with his admission number, and is filed 
with his record in the Out-patient Department. 
98 



APPENDIX 



99 



YOUNGSTOWN HOSPITAL ASSOCIATION 

OUT-PATIENT DEPARTMENT REFERENCE C^RD 




SERVICES REQUIRED OF,0. P. D^— 
DATE4?^^.<^..1 9 !..<*• SIGI 




M, D. 



Fig. 31. — Card referring patient from the Hospital Ward to the Out-patient 
Department for service. 



NOTICE 

PATIENTS RECEIVING THIS BLANK MUST PRESENT IT AT THE OUT- 
PATIENT DEPARTMENT DURING THE HOURS OF IO A. M. TO II A. M. ON 
THE DATE INDICATED BELOW 




'4 



THE OUT-PATIENT DEPARTMENT IS OPEN FOR THE TREATMENT OF 
PATIENTS EVERY DAY EXCEPT SUNDAY AND HOLIDAYS. 



Fig. 32. — Reverse side gives definite information which insures against 
any mistake on the part of the patient, and if he is interested in his own 
welfare he will find his way to the 0. P. D. These blanks illustrate the 
unification of work spoken of at the beginning of Chapter II. 



IOO 



" THE HOSPITAL AS A SOCIAL AGENT " 



The Youngstown Hospital Association 

Out-Patient Department 
Social History and Record 



Cue No. 



XL 



J- 



Woman £ $- $~ / 



M 3 y w a& 



Length of Tir 
J ^ State / 



Support .of Family 



Weekly Wage 



Namei of Children 



Phyjical Defect* or Other Extenuating Ci 



Age 

+4- 



4JL 



\Q.A n .^«*t $ dip 



3- 



Fig. 33. — Family history blank which may be introduced when the work 
in the O. P. D. becomes large enough to justify the separate record blank. 
This is yellow in color, and serves as the social history for all members of the 
family by referring to the family number. Time is thus saved and confusion 
resulting in different spelling of the surname, and the family becomes a 
unit on the records of the department. The first member of the family 
admitted establishes the family number, and the same index card is used 
by adding the family number above the case number. 



APPENDIX 



IOI 




JUL 26 Mr;*- A '»g l41Q^^ S£PB 1317*— 



JUL28 1917^ A U fl 16 19 17* — 
JUL311917^ AUG 18 1017*— Z 



AUG 2 t. 9 17» — A l)G 21 1 917 



AUG 4 1917k- A IJfig3 19 17 



AUG 7 19I7^~ AUG 25 1917 



AUG 9 1917^~ AUG 29 1917 



AUG 11 1917^ AUG 31 1917 . 



Fig. 34. — This card is used for the active file of cases, and at the end of 
the year facts concerning the year's work may be made from these cards. 
They also serve to keep track of the return dates for patients, as the ad- 
vance date is transferred from the medical history card to this one each day, 
and notification may be sent to patients to return, or the case may be visited. 



THE YODNGSTOWN HOSPITAL ASSOCIATION 

O. P. D. 

Name — 

B 



._M. D. 



No. 
Date 



Fig. 35. — Prescription blank. This is pink in color. 



102 



"the hospital as a social agent" 



The Youngstown hospital Association 

DENTAL CLINIC 



NO..—.... NAME - .. ADDRESS ,. 




MARK IN NED, TEETH MIS8INO ON ADMISSION 



COMPLAINT, 



Fig. 36. — Dental history card. 



APPENDIX 103 



PREVIOUS HISTORY 



HISTORY PRESENT TROUBLE 



EXAMINATION 



REVISIT DATES 



EXAMINED BY INT. 



Fig. 37. — Reverse side of dental history card. 



io4 



"the hospital as a social agent" 



YOUNGSTOWN HOSPITAL DENTAL CLINIC 



Patients must not leave the Retiring Room until the bleeding has completely stopped. 

At home wash out the mouth with warm salt water every hour, and after each 
meal (Add a pinch of table salt to one-half glass of water and use up at once.) 

If bleeding should again start, the patient must not wash out the mouth as this 
would promote bleeding. Instead, place a large wad of clean surgical cotton over 
the extraction wound, and close the jaws tighdy, and keep closed for fifteen min- 
utes by the watch. If the bleeding does not stop, replace the cotton by a fresh 
wad, and at once return to the Hospital. 

If, after the first treatment at the Hospital relief is not obtained, or, if pain has 
returned, the patient is requested to again call at the Hospital 

Charge* (or Extraction i Without Cm, No Charge. With Gat, 50c With Nomaloe, 25c 
Clinic Hours : Daily 9 to 12 and 1 to 4. 

OVER 



Fig. 38. 



Decayed teeth are the cause of many serious 
illnesses. 

The best way to prevent decay is to keep 
teeth clean. 

Clean teeth are more essential to health than 
dean face and hands. 

Teeth should be brushed after each meal end 
at bed tune. 



Fig. 39. — Reverse side of Fig. 38. 



APPENDIX 



YOUNGSTOWN HOSPITAL 
DENTAL CLINIC 

CLINIC HOURS. 8 TO 4 NO SUNDAY WORK 

- — — has an 

Appointment on 



Mon 


at 


Thur. 


-...at 




.'. at 


Fri. 


at 


Wed 


at 


Sat 


at 



THIS ENGAGEMENT MUST BE PROMPTLY KEPT. FIFTEEN MINUTES 
GRACE IS ALLOWED. AFTER WHICH TIME IT MAY BE CANCELLED 
--OVER— 



Fig. 40. 



Patient must bring this card when returning to clinic. 

The Patient is expected to notify the Dentist in case 
of Inability to keep appointment. 

The fees charged are only sufficient to cover materials 
used and are to be paid at each, visit. 



Fig. 41. — Reverse side of Fig. 40 
Figs. 36-41. — A set of dental cards used in dental clinic. 



Farm ti<i2 3W-IM6 

THE YOUNGSTOWN HOSPITAL ASSOCIATION 

O. P. D. 



Obstetric Case Record. Service of Dr.. 
Family History 



Personal History . 



Previous Obstetrical History . . . 

No. pregnancies _ _. _ _ _ _ Miscarriages.. 

Easy. _. T _ Difficult... Operation 

Gynaecological Examination — Para _ _ _ _ 

Date of last menstruation _ _ Date of quickening... 

Probable date of confinement 

Headache Backache Oedema ...Bowels. - 

Varicose veins _ ....Nausea _ Vomiting _. .Bleeding.. 

Breasts R. Nipple L. Nipple .. 

Right - Left _ Flat 

_ _ Eroded 

FOETUS 

Position... _ _ ..Location of forehead Dorsal . 

Small Parts _ _ Size _. Presenting part 

Rate of heart _ _ Where heard... - _ 

Relation of presenting part to brim: Above Partly through. 

Bladder _ __ _ „ 

ABDOMEN 



Thin. 














Symphysis to Fundus 






Crests. 





















External Oblique R... 
External Oblique L... 



Uterine Elevation Amount Liquid AmniL. 

1 06 



APPENDIX 



107 



INTERNAL MEASUREMENTS 

True Conjugate ._ „ _.Cocyi Movable 

Tran*. Dlaro. of Petri*. _ 

VoItb... _ Vagina.-. Urethra. 

Perineal Tear*. _ __ Uterus All*- 

Cerrtji Open— _ Closed..- 

PHYSICIAN'S NOTES 



— Cystocele Jlectocele 



Tear*— 



HISTORY OF LABOR 

Date _ Time of arrival at home..- Time of departure- 
Duration of labor _ 1st Stage 2nd Stage 3rd Stage 

Position of head. ._ _ — - - - 

•Character of pain- — - medication— 

General condition..- - .Foetal heart.- _ 

Perineal injur; and repair- - - - 



Child: Time of birth. — 
Abnormalities. 



-Weight 



Fig. 42. — Obstetric case record card, used for examination of patients 
cared for through the co-operation of district nurses spoken of in Chapter VI. 
This is a folded card with four pages, and conforms in size to other medical 
history cards. 



108 " THE HOSPITAL AS A SOCIAL AGENT " 

Forms reproduced above are distinctively Social Service 
and Out-patient Department blanks; #-ray, laboratory, and 
any others needed are those used in the hospital for such 
purposes. 

Four different colors are used for the medical history 
cards (Fig. 28): red for surgical; green for eye, ear, nose, 
and throat; blue for medical, and white for orthopedic and 
genito-urinary, distinguishing the last two by stamping with 
a rubber stamp at the top of the card, ORTHOPEDIC, 
GENITO-URINARY. History cards for the different clinics 
are quickly recognized in this way, and as the little round 
tickets (Fig. 27) correspond in color and title, the disposition 
of patients is readily accomplished. 

When a patient applies for treatment the social history 
is taken on blank form (Fig. 20 or 33), index card (Fig. 21) 
is filled in, admission card (Fig. 22) is made out and given 
to him (for which 10 cents is collected), and he receives a 
"Patient's check" with the round ticket indicating the clinic. 
The medical card is then headed with the number, name, 
address and date, and placed in the clinic room. The 
patient is then ready for the doctor's examination. 



APPENDIX 109 



CHARITY 

ORGANIZATION 

SOCIETY 


c 

\\ /* 

0 \\ / / 
\ \\ / / E 

P\\\ / / y 


HOSPITAL 
CARE 


«m 

CHARITIES 


TREATMENT IN 
OUT-MIHHT 
DEPARTMENT 


FEDERATED 

JEWISH 

CHARITIES 


GLASSES AITD 
SURGICAL 
APPLIANCES 
SUPPLIED 


VISITWS 
NURSE 

ASSOCIATION 


R ^51§ 

a y^y// 

T / / / 




// / R 
V 


TRANSPOR- 
TATION 


SCHOOL NURSES 


HOSPITAL 
SOCIAL SERVICE 
DEPARTMENT 


CHILDREN'S 
AID SOCIETY 


ACCOMPANYING 
TO 

TRAINS, HOMES 
INSTITUTIONS 


PROBATE COURT 
JUVENILE COURT 




MESSAGES TO 

FRIENDS 
LETTERS 
ADVICE 


BOARD OP 
HEALTH 


/ / / \ \ ^ 

I / / \ \ 

/ / \ E 
0 / \ 

4l 


TEMPORARY 
LODGING 


MISSION 
SETTLEMENT 


CLOTHING 
SUPPllBD 


PASTORS AND 
INDIVIDUAL 
CITIZENS 



Fig. 43. — Diagram showing features in detail which make the hospital a 
social agent in the community. 



INDEX 



Adversity, social service in, 32 

Births, illegitimate, father in, 51 
problem of, 47 

Cases, illustrative, 14, 35-39, 43, 52, 
56, 62, 63, 64, 67, 69, 73, 80 

Children, crippled, 67 
hospital, problem of, 58 

rights of parents in cases of, 60 

Chronic disease cases, social service in, 
33 

Clinics for nervous cases, 46 
Community, social service to, 40 
Conservation of human energy, 71 
Crippled children, 67 

Dispensary, definition of, 18 
duties of social service worker, 21 
establishment of, for clinical uses, 18 

on social service basis, 17 
field of, in medical education, 18 
obstetric service, 62 
patient, treatment of, 16 
service, patients eligible for, 71, 72 
work in tuberculosis, 44 

District nurse and social worker, co- 
operation of, 28 

Education, medical, field of dispensary 
in, 18 

Energy, human, conservation of, 71 

Epilepsy, cases of, 45 

Eye diseases, social service in, 85 



Father in illegitimacy, problem of, 51 
Feeblemindedness, cases of, 45 
Follow-up work in social service, 21 
Free patient, treatment of, 16 

Health work, public, hospital in, 79 
Home, relation of hospital social ser- 
vice to, 14 
Hospital as medicosocial agent, 20 
children, problem of, 58 

rights of parents in case of, 60 
in public health work, 79 
modern, scope of, 17 
physician, compensation to, for free 

service, 16 
social service department, 13, 17. 
See also Social senice, hospital. 
Human energy, conservation of, 71 

Illegitimate births, father in, 51 

problem of, 47 
Illustrative cases, 14, 35-39, 43, 62, 63, 

64, 67, 69, 73, 80 
Individual, social service to, 40 
Injury, social service in, 32 
Insanity, cases of, 45 

social service in, 33 

Keeping records in social service, 
forms for, 89-108 

Malpractice in social service, 12 
Medical education, field of dispensary 
in, 18 

xiz 



112 



INDEX 



Medicine, analogy to social service, 
12 

Mother, unmarried, problem of, 47 

Nervous cases, clinics for, 46 
Nurse, district, social service worker 
and, co-operation of, 28 

Obstetric service, dispensary, 62 
Officials, public, and social service, 77 
Out-patient department. See Dispen- 
sary. 

Patients eligible for dispensary ser- 
vice, 71, 72 
Physician and social worker, team- 
work between, 15 
hospital, compensation to, for free 
service, 16 
Prophylaxis in social service, 12 
Public health work, hospital in, 79 

relation of social service to, 20 
officials, social service and, 77 

Record keeping in social service, forms 

for, 89-108 
Reference blanks in social service, 89 

Sanatorium in tuberculosis, advan- 
tages of, 44 
Sickness, social service in, 32 
Social history of applicant, obtaining, 
12 

service, 11 

analogy to medicine, 12 
application in individual cases, 12 
as self-defense of society, 60 
basis for dispensaries, 17 
cases, variety of, 19 
completion of, to patient, 22 
conservation of human energy by, 
71 

constructive qualities of, 26 



Social service, correlation with other 

social agencies, 23 
definite aims of, 22 
development of, 11, 87 
diagram of features, 109 
follow-up work in, 21 
for crippled children, 67 
hospital, department of, 13, 17 

natural growth of, 13 

opportunities of, 34 

organization of, 21 

relation to home, 14 
in chronic diseases, 33 
in dispensary obstetric service, 

63 

in epilepsy, 45 
in eye diseases, 85 
in feeblemindedness, 45 
in illegitimate births, 47 
in injury, 32 
in insanity, 33, 45 
in problem of unmarried mother, 
47 

in sickness, 32 

in treatment of wounded soldiers, 
78 

in tuberculosis, 33, 42 
in venereal diseases, 80, 84 
malpractice in, 12 
proper limitations of, 31 
prophylaxis in, 12 
public officials and, 77 
reasons for existence of, 11 
record keeping in, forms for, 89- 
108 

reference blanks in, 89 
relation of, to other social agencies, 
23 

to public health, 20 
specialism in, 13 
to community, 40 
to individual, 40 
to society, 40 



INDEX 



Social service worker and district 
nurse, co-operation of, 28 
dispensary duties of, 21 
head, duties of, 21 
physician and, team-work be- 
tween, 15 
qualifications necessary for, 21 
selection of, 21 
Society, social service to, 40 
as self-defense of, 60 
Soldiers, wounded, social service in 

treatment, 78 
Specialism in social service, 13 
8 



"3 

Team-work between social worker and 

physician, IS 
Tuberculosis, cases of, 41 
social service in, 33 

dispensary work in, 44 

sanatorium in, advantages of, 44 

Unmarried mother, problem of, 47 

Venereal diseases, social service in, 
80, 84 



Books for Nurses 



PUBLISHED BY 

W. B. SAUNDERS COMPANY 
West Washington Square Philadelphia 

London: 9, Henrietta Street, Covent Garden 



Sanders' N ursing new <2d) edition 

This new edition is undoubtedly the most com- 
plete and practical work on nursing ever pub- 
lished. Miss Sander's already superior work 
has been amplified and the methods simplified to 
bring it down to the newest ideas in nursing. 
There is none other so full of good, practical 
information detailed in a clean-cut, definite way. 

Modern Methods in Nursing. By Georgiana J. Sanders, 
formerly Superintendent of Nurses at Massachusetts Gen- 
eral Hospital. 12mo of 900 pages, with 217 illustrations. 
Cloth, $2.50 net. Published August. 1916 

Dunton's Occupation Therapy 

EMPHASIZING BASIC PRINCIPLES 

Dr. Dunton gives those forms likely to be of most 
service to the nurse in private practice. You get 
chapters on puzzles, reading, physical exercises, 
card games, string, paper, wood, plastic and 
metal work, weaving, picture puzzles, basketry, 
chair caning, bookbinding, gardening, nature 
study, drawing, painting, pyrography, needle- 
work, photography, and music. 

Occupation Therapy for Nurses. By William Rush 
DUNTON, Jr., M. D., Assistant Physician at Sheppard 
and Enoch Pratt Hospitals, Towson, Md. i2mo of 240 
pages, illustrated. Cloth, $1.50 net. October. 1915 



Our books are revised frequently, so that the edi- 
tion you find here may not be the latest. Write 
us about any books in which you are interested. 



Stoney's Nursing 



NEW (5th) EDITION 



Of this work the American Journal of Nursing says: "It is the 
fullest and most complete and may well be recommended as 
being of great general usefulness. The best chapter is the one 
on observation of symptoms which is very thorough." There 
are directions how to improvise everything. 

Practical Points in Nursing. By Emily M. A. Stoney. Revised 
by Lucy Cornelia Catlin, R. N., Youngstown Hospital, Ohio. 
12mo, 511 pages, illustrated. Cloth, $1.75 net. Published August, 1916 



Stoney's Materia Medica 

Stoney' s Materia Medica was written by a head nurse who 
knows just what the nurse needs. American Medicitie says 
it contains "all the information in regards to drugs that a 
nurse should possess." 

Materia Medica for Nurses. By Emily M. A. Stoney, formerly Super- 
intendent of the Training School for Nurses in the Carney Hospital, 
South Boston, Mass, New (4th) Edition in preparation. 



Stoney's Surgical Technic new ( 4,h) edition 

The first part deals with bacteriology, including antitoxins; the 
second with all the latest developments in surgical technic. 
The National Hospital Record says : "Pregnant with just the 
information nurses constantly need." 

Bacteriology and Surgical Technic for Nurses. By Emily M. A. 

Stoney. 342 pages, illustrated. Cloth, $1.75 net. October, 1916 



Goodnow's First- Year Nursing 2d EDITION 

Miss Goodnow's work deals entirely with the practical side of 
first-year nursing work. It is the applicatwi of text-book 
knowledge. It tells the nurse how to do those things she is called 
upon to do in her first year in the training school — the actual 
ward work. 

First-Year Nursing. By Minnie Goodnow, R. N., formerly Super- 
intendent of the Women's Hospital, Denver. 12mo of 354 pages, 
illustrated. Cloth, $1:50 net. Published February, 1916 



Aikens' Hospital Management 



This is just the work for hospital superintendents, training- 
school principals, physicians, and all who are actively inter- 
ested in hospital administration. The Medical Record saj^s: 
"Tells in concise form exactly what a hospital should do 
and how it should be run, from the scrubwoman up to its 
financing." 

Hospital Management. Arranged and edited by Charlotte A. 
Aikens, formerly Director of Sibley Memorial Hospital, Washing- 
ton, D. C 488 pages, illustrated. Cloth, S3. no net. April, 1911 



Aikens' Primary Studies NEW (3d) EDITION 

Trained Nurse and Hospital Review says: " It is safe to say 
that any pupil who has mastered even the major portion of 
this work would be one of the best prepared first year pupils 
who ever stood for examination." 

Primary Studies for Nurses. By Charlotte A. Aikens, formerly 
Director of Sibley Memorial Hospital, Washington, D. C. 12mo of 
472 pages, illustrated. Cloth, $1.75 net. Published June, 1915 

Aikens' Training-School Methods and 
the Head Nurse 

This work not only tells how to teach, but also what should 
be taught the nurse and hozv much. The Medical Record says: 
" This book is original, breezy and healthy." 

Hospital Training-School Methods and the Head Nurse. By Char- 
lotte A. Aikens, formerly Director of Sibley Memorial Hospital, 
Washington, D. C. 267 pages. Cloth, $1.50 net. October, 1907 

Aikens' Clinical Studies NEW (3d) EDITION 

This work for second and third year students is written on the 
same lines as the author's successful work for primary stu- 
dents. Dietetic and Hygienic Gazette says there " is a large 
amount of practical information in this book." 

Clinical Studies for Nurses. By CHARLOTTE A. Aikens, formerly 
Director of Sibley Memorial Hospital, Washington, D. C. i2mo of 
56q pages, illustrated Cloth, $2.00 net. Published August, 1916 



Bolduan & Grund's Bacteriology 2d EDITION 

The authors have laid particular emphasis on the immediate 
application of bacteriology to the art of nursing. It is an 
applied bacteriology in the truest sense. A study of all the 
ordinary modes of transmission of infection are included. 

Applied Bacteriology for Nurses. By Charles F. Bolduan, M.D., 
Director Bureau of Public Health Education, and Marie Grund, 
M. D , Bacteriologist, Department of Health, City of New York 
188 pages, illustrated. Cloth, $1.50 net. Published November. 1916 



Fiske's The Body anew idea 

Trained Nurse and Hospital Review says "it is concise, well- 
written and well illustrated, and should meet with favor in 
schools for nurses and with the graduate nurse." 

Structure and Functions of the Body. By Annette Fiske, A. M., 
Graduate of the Waltham Training School for Nurses, Massa- 
chusetts. i2mo of 22i pages, illustrated. Cloth, $1.25 net. May. 1911 



Beck's Reference Handbook THIRD EDITION 

This book contains alt the information that a nurse requires 
to carry out any directions given by the physician. The 
Montreal Medical Journal says it is " cleverly systematized and 
shows close observation of the sickroom and hospital regime. " 

A Reference Handbook for Nurses. By Amanda K. Beck, Graduate 
of the Illinois Training School for Nurses, Chicago, 111. 32mo of 244 
pages. Bound in flexible leather, $1.25 net. February. 1913 



Roberts' Bacteriology & Pathology ^£2 

This new work is practical in the strictest sense. Written 
specially for nurses, it confines itself to information that the 
nurse should know. All unessential matter is excluded. The 
style is concise and to the point, yet clear and plain. The text 
is illustrated throughout. 

Bacteriology and Pathology for Nurses. By Jay G. Roberts, Ph. G., 
M. D., Oskaloosa, Iowa. 206 pages, illus. $1.50 net. August, 1916 



4 



DeLee's Obstetrics for N urscs N E E DITI 5 ON 

Dr. Del^ee's book really considers two subjects — obstetrics 
for nurses and actual obstetric nursing. Trained Nurse and 
Hospital Review says the "book abounds with practical 
suggestions, and they are given with such clearness that 
they cannot fail to leave their impress." 

Obstetrics For Nurses. By Joseph B. De1,ee, M. D., Professor of 
Obstetrics at the Northwestern University Medical School, Chicago. 
12mo volume of 550 pages, illustrated. Cloth, $2.75 net. July. 1917 



Davis' Obstetric & Gynecologic Nursing 

JUST OUT— NEW (5th) EDITION 

T/ie Trained Ntirse and Hospital Review says: " This is one 
of the most practical and useful books ever presented to the 
nursing profession." The text is illustrated. 

Obstetric and Gynecologic Nursing. By Edward P. Davis, M. D., 
Professor of Obstetrics in the Jefferson Medical College, Philadel- 
phia. 48" pages, illustrated. Cloth, $2.00 net. Published May. 1917 

Macfarlane's Gynecology for Nurses 

SECOND EDITION 

Dr. A. M. Seabrook, Woman's Hospital of Philadelphia, says: 
"It is a most admirable little book, covering in a concise but 
attractive way the subject from the nurse's standpoint." 

A Reference Handbook of Gynecology for Nurses. By Catharine 
Macf arlane, M. D., Gynecologist to the Woman's Hospital of Phila- 
delphia. 32mo of 156 pages, with 70 illustrations. Flexible leather, 
$1.25 net Published May. 1913 



Asher's Chemistry and Toxicology 

Dr. Asher's one aim was to emphasize throughout his book 
!he application of chemical and toxicologic knowledge in the 
study and practice of nursing. He has admirably succeeded. 

i2mo of 190 pages. By Philip Asher, Ph. G., M. D., Dean and Pro- 
fessor of Chemistry, New Orleans College of Pharmacy, Cloth, 
$1.25 net. Published October, 1914 



5 



Aikens' Home Nurse's Handbook ™.on 

The point about this work is this: It tells you, and shows you 
just how to do those little things entirely omitted from other 
nursing books, or at best only incidentally treated. The 
chapters on "Home Treatments" and "Every-Day Care of 
the Baby," stand out as particularly practical. 

Home Nurse's Handbook. By Charlotte A. Aikens, formerly Di- 
rector of the Sibley Memorial Hospital, Washington, D. C. umo of 
303 pages, illustrated. Cloth, $1.50 net. Published March, 1917 

Eye, Ear, Nose, and Throat Nursing 

This book is written from beginning to end for the nurse. You 
get antiseptics, sterilization, nurse's duties, etc. You get an- 
atomy and physiology, common remedies, how to invert the 
lids, administer drops, solutions, salves, anesthetics, the 
various diseases and their management. New {2d) Edition. 

Nursing in Diseases of the Eye, Ear, Nose and Throat. By the 
Committee on Nurses of the Manhattan Eye, Ear and Throat Hospital. 
i2mo of 291 pages, illustrated. Cloth, $1.50 net. Published Sept. 1915 

Paul's Materia Medica NEW (3d) EDITION 

In this work you get definitions — what an alkaloid is, an in- 
fusion, a mixture, an ointment, a solution, a tincture, etc. 
Then a classification of drugs according to their physiologic 
action, when to administer drugs, how to administer them, 
and how much to give. 

A Text-Book of Materia Medica for Nurses. By George P. Paul, M.D. 
12mo of 295 pages. Cloth, $1.50 net. Published August, 191 7 

Paul's Fever Nursing NEW (3d) EDITIO n 

In the first part you get chapters on fever in general, hygiene, 
diet, methods for reducing the fever, complications. In the 
second part each infection is taken up in detail. In the third 
part you get antitoxins and vaccines, bacteria, warnings of 
the full dose of drugs, poison antidotes, enemata, etc. 

Nursing in the Acute Infectious Fevers. By George P. Paul, M. 1) 
12mo of 275 pages, illustrated. Cloth, $1.00 net. October. 1915 



6 



McCombs' Diseases of Children for Nurses 

NEW (3d) EDITION 

Dr. McCombs' experience in lecturing to nurses has enabled 
him to emphasize just those points that nurses ?nost need to know. 
Natio?ial Hospital Record says: "We have needed a good 
book on children's diseases and this volume admirably fills 
the want." The nurse's side has been written by head 
nurses, very valuable being the work of Miss Jennie Manly. 

Diseases of Children for Nurses. By Robert S. McCombs, M. D.. 
Instructor of Nurses at the Children's Hospital of Philadelphia. i2mo 
of 509 pages, illustrated. Cloth, $2.00 net. Published June, 1916 

Wilson's Obstetric Nursing 

NEW (3d) EDITION 

In Dr. Wilson's work the entire subject is covered from the 
beginning of pregnancy, its course, signs, labor, its actual 
accomplishment, the puerperium and care of the infant. 
American Journal of Obstetrics says: " Kvery page empasizes 
the nurse's relation to the case." 

A Reference Handbook of Obstetric Nursing. By W. Reynolds 
Wilson, M. D., Visiting Physician to the Philadelphia Lying-in 
Charity. 355 pages, illus. Flexible leather. $1.25 net. April, 1916 



American Pocket Dictionary NEW (10th) EDITION 

The Trained Nurse and Hospital Review says: "We have 
had many occasions to refer to this dictionary, and in every 
instance we have found the desired information." 

American Pocket Medical Dictionary. Edited by W. A. Newman 
Dorland, A. M., M. D. Flexible leather, gold edges, $1.25 net; 
indexed, $1.50 net. Published September, 1917 



THIRD 
EDITION 



Lewis' Anatomy and Physiology 

Nurses Journal of Pacitic Coast says "it is not in any sense 
rudimentary, but comprehensive in its treatment of the sub- 
jects." The low price makes this book particularly attractive. 

Anatomy and Physiology for Nurses. By I,eRoy I/?wis, M.D. 12mo 
of 326 pages; 150 illustrations. Cloth, $1.75 net. 

Published September, 1913 



Goodnow's War Nursing 



JUST OUT 



Written at the front and on the battlefield, this book shows the 
inexperienced nurse how to care for a ward of wounded men 
from arrival to dismissal; it introduces you to actual conditions, 
and shows you how they are best met. 

War Nursing: a Text-Book for Auxiliary Nurses. By Minnie Good- 
now, R. N., War Nurse in France. 172 pages, illustrated. Cloth, 
$1.50 net. Published December, 1917 

Warnshuis' Surgical Nursing 

The author gives you here the essential principles of surgical 
nursing, and reliable fundamental knowledge based on his 
own personal conclusions and experiences. Secondary matter 
is excluded, and all primary and pertinent points are set down 
briefly and concisely. 

Octavo of 2~>1 pages, with 255 illustrations. By Frederick C. 
Warnshuis, M.D., F.A.C.S., Visiting Surgeon, Butterworth Hos- 
pital, Grand Rapids, Michigan. Cloth, $2.50 net. 

Published March, 1918 

Friedenwald and Ruhrah's Dietetics for 

Nurses new (4th) edition 

This work has been prepared to meet the needs of the nurse, 
both in training school and after graduation. American Jour- 
nal of Nursing says it "is exactly the book for which nurses 
and others have long and vainly sought." 

Dietetics for Nurses. By Julius Friedenwald, M. D., and John 
Ruhrah, M l)., University of Maryland School of Medicine and 
College of Physicians and Surgeons, Baltimore. 12mo volume of 467 
pages. Cloth, $1.50 net. Published July, 1917 



FOURTH 
EDITION 



Friedenwald & Ruhrah on Diet 

This work is a fuller treatment of the subject of diet, pre- 
sented along the same lines as the smaller work. Everything 
concerning diets, their preparation and use, coloric values, 
rectal feeding, etc., is here given in the light of the most re- 
cent researches. Published July, i9U 

Diet in Health and Disease. By Julius Friedenwald, M.D., and 
John Ruhrah, M.D. Octavo volume of 857 pages. Cloth, $4.00 net 



Catlin's Hospital Social Service 

Miss Catlin's book is especially planned to help those who are 
establishing social service centres in new fields, as well as 
those in dispensaries already firmly established. She has had 
the practical experience of many years to draw upon. 

The Hospital as a Social Agent in the Community. By I,ucy Cor- 
nelia Catlin, R.N., Director of Social Service Work and Executive 
Director of the Out-Patient Department, Youngstown Hospital, 
Ohio. 12mo of 113 pages, with 43 illustrations. Published May, 1918 

Galbraith's Personal Hygiene and Physical 

Training for Women NEW (2d) EDITION 

Dr. Galbraith's book tells you how to train the physical pow- 
ers to their highest degree of efficiency by means of fresh air, 
tonic baths, proper food and clothing, gymnastic and outdoor 
exercise. There are chapters on the skin, hair, development 
of the form, carriage, dancing, walking, running, swimming, 
rowing, and other outdoor sports. 

Personal Hygiene and Physical Training for Women. By Anna M. 
Galbraith, M.D., Fellow New York Academy of Medicine. i2mo of 
393 pages, illustrated. Cloth, $2.25 net. Published January, 1917 

Galbraith's Four Epochs of Woman's Life 

This book covers each epoch fully, in a clean, instructive way, 
taking up puberty, menstruation, marriage, sexual instinct, 
sterility, pregnancy, confinement, nursing, the menopause. 

The Four Epochs of Women's Life. By Anna M. Galbraith, M.D., 
with an Introductory Note by John H. Musser, M. D. 12mo of 296 
pages. Cloth, $1.50 net. Third Edition published March, 1917 

Griffith's Care of the Baby NEW (6th) EDITION 

Here is a book that tells in simple, straightforward language 

exactly how to care for the baby in health and disease; how 

to keep it well and strong; and should it fall sick, how to 

carry out the physician's instructions and nurse it back to 

health again. Published j u ne, 1915 

The Care of the Baby. By J. P. Crozer Griffith, M.D., Univers- 
ity of Pennsylvania. i2mo of 458 pages, illustrated. Cloth, $1.50 net 



Q 



Aikens' Ethics for Nurses ™s™i N o™S 

This book emphasizes the importance of ethical training. It 
is a most excellent text-book, particularly well adapted for 
classroom work. The illustrations and practical problems 
used in the book are drawn from life. 

Studies in Ethics for Nurses. By Charlotte A. Aikens, formerly 
Superintendent of Columbia Hospital, Pittsburg. i2mo of 518 pages. 
Cloth, $1.75 net. Published April. 1916 



Goodnow's History of Nursing 

Miss Goodnow's work gives the main facts of nursing history 
from the beginning to the present time. It is suited for class- 
room work or postgraduate reading. Sufficient details and 
personalities have been added to give color and interest, and 
to present a picture of the times described. 

History of Nursing. By MINNIE Goodnow, R.N., formerly Super- 
intendent of the Women's Hospital, Denver. i2mo of 370 pages, 
illustrated. Cloth, $2.00 net. Published December, 1916 



Berry's Orthopedics for Nurses 

The object of Dr. Berry's book is to supply the nurse with a 
work that discusses clearly and simply the diagnosis, prog- 
nosis and treatment of the more common and important ortho- 
pedic deformities. Many illustrations are included. The 
work is very practical. 

Or:hopedic Surgery for Nurses. By John McWilliams Berry, 
M.D., Clinical Professor of Orthopedics and Rontgenology, Albany 
Medical College. Cloth, $1.00 net. Published July, 1916 



Whiting's Bandaging 

This new work takes up each bandage in detail, telling you — 
and showing you by original illustrations — just how each 
bandage should be applied, each turn made. Dr. Whiting's 
teaching experience has enabled him to devise means for over- 
coming common errors in applying bandages. 

Bandaging. By A. D. Whiting, M.D., Instructor in Surgery at the 
University of Pennsylvania. i2tno of 151 pages, with 117 illustra- 
tions. Cloth, $1.25 net. Puolished November, 1915 



10 



Smith's Operating-Room 

The object is to show you how to assist the surgeon according 
to the newest operative technic. You get the result of active 
experience systematized, and in concise form. You get a thor- 
ough digest of every essential ; detailed lists of instruments ; 
glossary of medical terms. Every phase of the subject is 
covered by ample, practical instruction. 

The Operating-Room. A Primer for Nurses. By Amy Armour 
Smith, R.N., formerly Superintendent of Nurses at the Woman's 
Hospital of the State of New York. 12mo of 295 pages, illustrated. 
Cloth, $1.50 net. Published October, 1916 

Bandler's The Expectant Mother 

This is an anatomy, physiology and hygiene covering those 
points and functions concerned in child-bearing and designed 
for the use of the nurse and the mother. Every question of 
interest to the expectant mother is treated. 

The Expectant Mother. By S. Wyllis Bandler, M. T>., Professor 
of Diseases of Women, New York Post-Graduate Medical School 
and Hospital. Cloth, $1.25 net. Published October, 1916 

Winslow's Prevention of Disease 

Here you get a practical guide, giving you briefly the means 
to avoid the various diseases described. The chapters on diet, 
exercise, tea, coffee, alcohol, prevention of cancer, etc., are of 
special interest. There are, besides, chapters on the preven- 
tion of malaria, colds, constipation, obesity, nervous disorders 
and tuberculosis. It is a record of twenty-five years' active 
practice. 

By Kenelm Winslow, M.D., formerly Assistant Professor of Com- 
perative Therapeutics, Harvard University. 12mo of 348 pages, 
illustrated. Cloth, $1.75 net. Published November, 1916 

Brady's Personal Health 

This is different from other health books. It is written by a 
physician with some fifteen years' experience in writing for the 
laity. It covers the entire range of health questions — care of 
mouth and teeth, catching cold, adenoids and tonsils, eye and 
ear, ventilation, skin, hair and nails, nutrition, nervous ail- 
ments, etc. 

Personal Health. A Doctor Book for Discriminating People. By 

William Brady, M.D., Elmira, N.Y. 12mo of 400 pages. 

Cloth, $1.50 net. Published September. 1916 



11 



Hoxie & Laptad's Medicine for Nurses 

Medicine for Nurses and Housemothers. By George 
Howard Hoxie, M. D., University of Kansas; and 
Pearl L. Laptad. 12mo of 351 pages, illustrated. 
Cloth, $1.50 net. Second Edition— April, 1913 

Bohm & Painter's Massage 

Massage. By Max Bohm, M.D., Berlin, Germany. Ed- 
ited by Ciias. F. Painter, M.D., Tufts College. Octavo 
of 91 pages, 97 illustrations. Cloth, $1.75 net. June, 1913 

Boyd's State Registration for Nurses 

State Registration for Nurses. By Louie Croft Boyd, 
R. N., Graduate Colorado Training School for Nurses. 
Cloth, $1.25 net. Second Edition— February , 1915 

Morrow's Immediate Care of Injured 

Immediate Care of the Injured. By Alberts. Mor- 
row, M.D. , New York Polyclinic. Octavo of 354 pages, 
with 242 illustrations. Cloth, $2.75 net. 

Third Edition— November, 1917 

deNancrede's Anatomy EIGHTH EDITION 

Essentials of Anatomy. By Charles B. G. deNan- 
crede, M. D., University of Michigan. 12mo of 400 
pages, 180 illustrations. Cloth, $1.25 net. Sept., 1911 

Morris' Materia Medica SEVENTH EDITION 

Essentials of Materia Medica, Therapeutics, and Pre- 
scription Writing. By Henry Morris, M. D. Re- 
vised by W. A. Bastedo, M. D., Columbia University, 
New York. 12mo of 300 pages, illustrated. 
Cloth, $1.25 net. Published March, 1905 

Register's Fever Nursing 

A Text-Book on Practical Fever Nursing. By Edward C. 
Register, M.D., North Carolina Medical College. Oc- 
tavoof 350 pages, illustrated. Cloth, $2.50 net. June 1907 



12 



I